This episode breaks down one of the most high-yield SJT skills: choosing the safest next action when everything feels urgent. Using multi-layered ward, handover, and surgical near-miss scenarios, it shows you exactly how to apply the TRCCA hierarchy — Time-critical → Risk reduction → Capacity creation → Communication → Administration — to avoid cognitive overload, prevent errors, and consistently select the highest-scoring option.

0:00 Why prioritisation decides patient safety
00:28 Five competing tasks — the core dilemma
01:03 Structure over instinct
01:40 TRCCA: strict safety-first hierarchy
02:15 T = Time-critical threats
02:50 R = Risk reduction (imminent harm)
03:25 C = Capacity creation (delegation)
04:00 C2 = Communication (after stabilisation)
04:40 A = Administration (always last)
05:20 Scenario 1: ward crisis
06:05 Sepsis vs hyperkalaemia — twin priorities
06:50 Delegation as a safety intervention
07:25 Updating family safely
08:05 Scenario 2: handover chaos
08:55 Why self-doing admin is a trap
09:35 Delegation outranks communication
10:10 Scenario 3: theatre near-miss
10:45 Safety huddle → Candour → LFPSE → PSIRF
11:20 Blame destroys safety culture
12:00 Three rules for safe rapid prioritisation
12:40 Delegation protects your cognitive bandwidth
13:20 People before paperwork
14:00 Final takeaways

• Time-critical threats (arrest, sepsis, hyperkalaemia) always dominate
• Risk reduction sits just beneath — imminent deterioration must be stabilised
• Capacity creation (delegation, diverting bleeps, requesting help) is a clinical action
• Communication follows stabilisation — never before
• Administration is always last, even if “quick” or “helpful”
• Sepsis bundles often outrank similar risks due to fixed institutional timing
• In errors/near-misses: safety huddle → candour → logging → system review
• Avoid traps: doing admin yourself, delaying escalation, blame culture, informal shortcuts

Take-home mnemonics:
TRCCA — Time, Risk, Capacity, Communication, Admin
ABDEC — Sepsis, K+, Delegate, Explain to family, Chase scan
PACE-10 — 10-second micro-huddle
People > Paper — safety culture rule for incidents

Links:
• passthemsra.com – Complete MSRA revision, notes, mocks, flashcards
• freemsra.com – Free podcasts, threads and rapid-learning guides
• msra.io – Smart MSRA Qbank with analytics

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