Clinical Decision Framework
Clinical Decision-Making Under Pressure
Clinical decision-making is tested rigorously in the OSCE through complex scenarios that require quick thinking, systematic approaches, and calm execution under time pressure. This guide provides proven frameworks to excel in high-stakes clinical situations.
Critical Skills:
- • Rapid patient assessment and prioritization
- • Structured communication and escalation
- • Evidence-based intervention selection
Success Factors:
- • Systematic framework application
- • Clear reasoning and documentation
- • Calm, professional demeanor
1Manage a Deteriorating Patient
Use the ABCDE (Airway, Breathing, Circulation, Disability, Exposure) framework. Recognize signs of deterioration early, initiate basic interventions and call for help.
Early Warning Signs
Respiratory Changes:
- Increased respiratory rate (>20/min)
- Decreased oxygen saturation (<95%)
- Use of accessory muscles
Cardiovascular Changes:
- Heart rate >100 or <60 bpm
- Systolic BP <90 or >180 mmHg
- Prolonged capillary refill (>2 sec)
ABCDE Response Protocol
Airway
Ensure patent airway, position patient, suction if needed
Breathing
Assess respiratory effort, administer oxygen, assist ventilation
Circulation
Check pulse, blood pressure, establish IV access
Disability
Assess neurological status, check blood glucose
Exposure
Full body examination, maintain dignity and warmth
2Recognize and Escalate Sepsis
Know the SEPSIS SIX: oxygen, blood cultures, IV antibiotics, IV fluids, lactate measurement and urine output monitoring. Acting quickly can save lives.
SEPSIS SIX Protocol
Within 1 Hour - Give 3:
Within 1 Hour - Take 3:
3Prioritize Multiple Patients
When presented with several patients, use SBAR (Situation, Background, Assessment, Recommendation) and triage principles. Focus first on airway and breathing issues, then circulation and pain.
SBAR Communication Framework
S - Situation
What is happening right now?
B - Background
What led up to this situation?
A - Assessment
What do you think the problem is?
R - Recommendation
What do you want to happen?
Triage Priority Framework
Life-Threatening (Red)
Airway obstruction, respiratory failure, cardiac arrest
Urgent (Orange)
Severe pain, significant bleeding, altered consciousness
Semi-Urgent (Yellow)
Moderate pain, stable vital signs, minor injuries
Excel in Clinical Decision-Making with NAI
Practice using structured frameworks, justify your actions out loud and always consider patient safety. NAI's OSCE program offers simulation and feedback to build confidence.
Rapid Assessment
Quick, systematic patient evaluation
Priority Setting
Evidence-based triage decisions
Clear Communication
Structured SBAR reporting
Pressure Management
Calm, methodical approach
Found this helpful? Share it with your colleagues and friends.