Safer Care for Children in Hospital Research Program ​

The Safer Care for Children in Hospital Research Program commenced in 2019 as the ESCALATION research project that involved development of an evidence-based early warning system for recognising and responding to clinical deterioration in WA paediatric healthcare settings. Perth Children’s Hospital, all other WA health facilities, private hospitals, St John Ambulance WA, Royal Flying Doctor Service WA, and St John WA Urgent Care Clinics caring for sick children now use the early warning system, known as the ESCALATION system.

Components of the ESCALATION System

A key component of ESCALATION is its incorporation of family input in reporting changes in their child’s condition that can indicate early signs of deteriorating health. Family involvement is integrated in the ESCALATION System through proactively asking families:

• How do you think your child is doing?
• Has anything changed?
• Are you worried your child is getting worse?

To support families to report changes they notice in their child’s condition the Tell us if are worried poster was co-designed with health consumers and is now displayed at patient bedsides in Emergency Departments and hospital wards.

Program focus
Projects under the Safer Care for Children program seek to strengthen and refine the ESCALATION system. They include studies to optimise family involvement in reporting patient deterioration, particularly Aboriginal families, and those from culturally and linguistically diverse backgrounds.
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More information
For more information about these studies, please navigate to the project news tab.

Contact
Program lead: Professor Fenella Gill

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Safer care for children in hospital: ​Strengthening and sustaining the Paediatric ESCALATION System (SPECS)

​Thanks to funders WA Future Health Research and Innovation Fund and Perron Charitable Foundation in 2023 the Safer care for children in hospital research program expanded to a second phase called SPECS (Strengthening and sustaining the Paediatric ESCALATION System). The SPECS program consists of four key projects and associated research activities as illustrated below:

Under the SPECS program, we are conducting four different sub-studies in collaboration with health professionals and families to:

1. identify factors impacting implementation, normalisation and integration of the ESCALATION system in WA Country Health Service clinical sites.
2. identify barriers and facilitators to health professional and family engagement with the ESCALATION system ‘family concern’ component.
3. identify barriers and enablers for families of Aboriginal children to identify when their child’s condition is deteriorating and raise concerns in hospital.
4. determine the optimal escalation of care thresholds and early warning score variable parameters that are independently associated with clinical deterioration or sepsis for a (a) pre-hospital paediatric cohort and Emergency Department and (b) in-hospital case-control groups

In addition to the sub-studies above, the SPECS program also includes two doctoral studies exploring:

• culturally and linguistically diverse (CaLD) patient and carer escalation of care in hospital, and
  
• detection of clinical deterioration for children with dark coloured skin.
  

​In 2025, the Safer care for children in hospital research program received additional funding from Telethon 7 to expand sub-study 2. This new project, called Find your voice, involves co-designing a digital solution to support culturally and linguistically diverse (CaLD) families to raise their concerns at Perth Children’s Hospital (PCH).