ESCALATION

This project is supported by:

Early recognition of patient clinical deterioration followed by a prompt and effective response can minimise the occurrence of adverse events and may reduce the level of intervention required when delays occur. Failure to escalate care for a deteriorating patient can have devastating consequences, especially when the patient is a child.

In 2019 the ESCALATION System was developed as a result of literature review and benchmarking, consideration of human factor principles, extensive stakeholder engagement and consultation. The ESCALATION System was piloted tested for feasibility and acceptability in 6 WA hospitals (Perth Children's, Fiona Stanley, Joondalup, Broome, Albany and Narrogin). Further testing was conducted with a refined version of the ESCALATION system at Perth Children's Hospital and Broome Hospital. Findings from the 2019 & 2020 pilots resulted in minor changes and refinements.

The ESCALATION System combines 3 main features, charting, communication and family engagement:

Composite scoring system - 10 weighted variables; assessment of respiratory distress, respiratory rate, oxygen saturations, oxygen therapy, heart rate, central capillary refill time, blood pressure, level of consciousness (or level of sedation), pain score and clinician/family concern
5 charts: <3m, 3-12 m, 1-4y, 5-11y, 12y+
Respiratory distress assessment and oxygen delivery succinct and objective
Standardised, clear escalation pathway appropriate for different contexts
Standardised, clear sepsis pathway to facilitate sepsis recognition and early senior medical review for suspected sepsis
iSoBAR NOW timely escalation of care communication
Posters and flyers to promote family involvement

Final testing was completed at Perth Children's Hospital and Broome Hospital in September 2020. The System will be ready for state-wide implementation in 2021