1. ESCALATION System V5 We are updating the paediatric ESCALATION System (version 4) to paediatric ESCALATION System (version 5). Note: Child and Adolescent Health Service and Curtin University are joint owners of the ESCALATION charts copyright 2022.
ESCALATION System version 4 was implemented in 2022, and since then there has been several factors which warrant a further revision. This includes findings from the 2023 Safer Care for Children in Hospital Research Program, the development and implementation of the Sepsis Recognition Pathway in 2023, and the required inclusion of a variable to recognise and respond to mental health deterioration.
The update will involve refinements to
The suite of 5 age ranges PARROT charts (with context specific escalation pathways)
Family involvement resources
ESCALATION System education package
Auditing
A working group with statewide representation has been established to advise and agree on changes. Completion of this project is anticipated for late 2024. For further information please contact Professor Fenella Gil [email protected] or Margie Lane [email protected]
2. Presentation at the Congress of The World Federation of Paediatric Intensive & Critical Care Societies Professor Fenella Gill was an invited speaker at 12th Congress of The World Federation of Paediatric Intensive & Critical Care Societies, held at Cancun Mexico from 1-5 June 2024. Professor Gill’s presentation provided an opportunity to present our most recent research findings understanding perspectives of families, nurses and doctors on family involvement in escalation of care.
Professor Fenella Gill presenting at the congress.
International congress delegates.
April 2024 Update
We are well underway with data collection across 4 sub-studies within the research program.
Dr Eileen Boyle at Broome Health Campus
1. Embedding and Sustaining the ESCALATION system in WA country Health Service Data collection has commenced in six hospitals in WA Country Health Service including Bunbury, Broome, Geraldton, Narrogin, Carnarvon and Karratha.
We completed 13 focus groups with 9 doctors and 57 nurses between February 5th and March 20th, 2024. Overall, the nurse and doctors valued the additional benefit of the ESCALATION system in supporting them in the early identification of clinically deteriorating children in hospital. We will be visiting our final site in Karratha in April 2024.
2) Family involvement in ESCALATION System at Perth Children’s Hospital More than 350 nurses and doctors and over 350 families in the community completed online surveys. Thirty-two doctors and 32 nurses participated in in focus groups and 15 families participated in interviews. Analysis is currently underway.
We are hearing clearly that the integrated family involvement in the ESCALATION System is seen to be a very positive addition from everyone’s perspective. “We’ve learnt over the years is that parental instincts is really, really important and the other thing I think, involving families actively in caring and allowing them to escalate is really important.” P1F FG6- Doctor "Yes, they were asking for concerns, yes. And the hospital was very good at asking for concern the majority of the time to the point”. P14 - Parent.
L-R Dr Eileen Boyle, Mikayla Garstone, Professor Fenella Gill, Claudia Walton-McDermott.
3) Aboriginal Family involvement in ESCALATION System We have interviewed Aboriginal families at Perth Children’s Hospital to understand how they can raise their concerns about their child in hospital. Twelve families kindly took the time to share their stories with us. We have commenced data analysis.
Three study sites, Perth Children's' hospital, Broome and Port Hedland are in this study to understand Aboriginal families experiences of voicing their concerns when their child is getting sicker in hospital.
We are delighted to announce four new Aboriginal project officer team members, Mikayla Garstone and Claudia Walton-McDermott (Broome), Erica Thompson (Port Hedland), and Arizona Galbraith (Perth). Our Aboriginal project officers will facilitate data collection, analysis and interpretation in our study findings.
Dr Jo Zhou, Lisa Ma, and Martina Barnwell (not pictured) have been involved in data collection.
4) Predicting clinical deterioration using the ESCALATION System We have gathered data from more than 220 cases for our case-control study at Perth Children’s Hospital. We expect to continue collecting data until July 2024 to reach our target sample size of 450 cases.
Maggie Harrigan
Welcome to a New Team Member We are delighted to announce that Maggie Harrigan has joined our research team. Maggie is a senior social worker and researcher. Her background includes several years of experience providing psychological and social support to people in hospital, with a passion for patient advocacy and empowerment.
Maggie’s role will be to focus on project 5 – to develop an online way for families to escalate care. Maggie will be working to adapt a UK designed online application that enables families from culturally and ethno-linguistically diverse backgrounds to raise concerns about their child’s clinical deterioration in hospital in their own language. This project will involve co-design with stakeholders and health consumers to ensure the application is adapted to meet the needs of WA families and available in the most common languages spoken in WA. Maggie recently met with the Safer care for children in hospital Consumer & Community Advisory Group to introduce herself and provide an overview of the project rationale and concept.
Major Milestone Achieved Chelsea Kelly’s PhD studies “Exploring factors influencing the detection of clinical deterioration in hospitalised children with darker coloured skin in Western Australia” has reached a major milestone. The research study has gained ethics approval through Child and Adolescent Health Service, Western Australian Aboriginal Health Ethics Committee, and Curtin University Ethics Committee. Data collection involving interviews and focus groups with health professional and parents and carers is planned to commence after Easter. Chelsea is the recipient of a PhD scholarship awarded for the Safer care for children in hospital research program by the WA Future Health and Research Innovation Fund.
Professor Fenella Gill, Dr Eileen Boyle, Sarah Rooney and Katarina Barjaktarevic.
PhD candidate looking to better support Culturally and Linguistically Diverse (CALD) patients and carers Congratulations to Fiona Stanley Hospital (FSH) registered nurse Sarah Rooney on recently achieving PhD candidacy at Curtin University. Sarah is a recipient of a Clinician Research Training PhD Scholarship awarded by the WA Future Health and Research Innovation Fund. Sarah’s project aims to co-design an intervention strategy to support patients and carers from Culturally and Linguistically Diverse (CALD) backgrounds to activate an escalation of care for clinical deterioration. Her project is planned to run throughout 2024-25 and will involve a literature review, review of escalation and MET calls for CALD patients, survey and interviews with staff, interviews with CALD patients, and co-design of an intervention strategy. A key strength of the project is involvement of CALD consumer representatives in the research process. Sarah is being supervised by Professor Fenella Gill, Dr Eileen Boyle, Emeritus Professor Gavin Leslie, and Dr Jo Zhou.
Consumer and Community Advisory Group In February we held the first Consumer & Community Advisory Group meeting for 2024, attended by 6 consumers and community members. The meeting focused on consulting members for the “Exploring factors influencing the detection of clinical deterioration in hospitalised children with darker coloured skin in Western Australia” research on interview questions and best presenting skin colour depiction. Maggie provided an overview of the planned project to develop an online way for families to escalate care and received feedback from the group. Presentations Professor Fenella Gill presented the keynote presentation for the Fiona Stanley Fremantle Hospitals Group Sustaining the change making improvements stick 8th Annual IMPROVE Conference 2024 which was held on the 21st of March. Professor Gill's presentation was titled "Developing a program of research Safer care for children in hospital".
Professor Fenella Gil presented at the ANZICS/ACCN Intensive Care Annual Scientific Meeting, incorporating the annual Paediatric and Neonatal Intensive Care Conference, which was held at the Brisbane Convention and Exhibition Centre from 10-12 April 2024. Professor Gill's presentation was titled "Improving assessment for paediatric clinical deterioration through the escalation system integrated family involvement".
Upcoming presentations
Professor Fenella Gill is planned to present at 12th Congress of The World Federation of Paediatric Intensive & Critical Care Societies, which will be held in Cancun Mexico from 1-5 June 2024.