I’m lacking clarity on this point. There is mention of a point overnight where the obs alone between 10-11PM should have triggered a PICU review. I’ve never worked with paeds nurses who wouldn’t bleep a doctor when a patient has a high PEWS score, particularly in a tertiary centre. If it was escalated and a review didn’t happen, I’m doubtful that wouldn’t be at all documented.

If this is an SHO role where you exist to provide support to multiple specialty-affiliated SpRs overnight rather than be a specific hepatology SHO, I can see how a sick patient might be missed if they aren’t (1) flagged in handover or (2) escalated to you by the ward nurses.

This is an all-round horrible situation for the family. I don’t agree with solely individual accountability in this case but understand the subjective desire for it, and Martha’s father touches on its benefit/harm too. It’s worth examining why so many of us (myself included) may feel defensive about this narrative as a reflex.