Please follow the link to read a summary of the work completed for the ESCALATION project in 2019 - Project Summary Report 2019
The ESCALATION project was successful in developing and trialling a proposed uniform system (ESCALATION System) for a state-wide approach to the recognition and response to clinical deterioration in children. The ESCALATION system was a product of widespread stakeholder and consumer input and review. This system is unique in incorporating a track and trigger chart (PARROT) with family concern fully integrated, escalation of care pathways, a framework for escalation communication (iSOBAR-NOW) and a uniform process for family escalation of care across WA health. At the six trial implementation hospitals the approach was well received. Feedback has been provided to further fine tune the system prior to final implementation and evaluation.
Our project report will be finalised soon and below are the key recommendations:
The ESCALATION project was undertaken in 2019 to develop an evidence-based system for recognising and responding to paediatric clinical deterioration that includes family participation suitable for state-wide implementation. The project was overseen by the state-wide ESCALATION Steering Group, comprising health consumers, health services stakeholders, users and researchers.
The project consisted of 3 phases:
We tested using the PARROT as a trial ESCALATION system in 6 metropolitan and country hospitals (Perth Children’s Hospital (PCH), Joondalup Health Campus, Fiona Stanley Hospital, Broome Hospital, Albany Hospital, Narrogin Hospital) and feedback is positive with strong support from all Health Service Providers and consumers.
The evaluation phase is well underway
Most of the six sites have completed staff focus groups. Some common feedback includes Claims
Staff surveys are being circulated. Now is the time for users of the PARROT to provide feedback. If you were working at a pilot site and wish to have your say about the ESCALATION system, please contact your manager or the ESCALATION project team.
Chart audits have been completed. A total of 249 charts have been reviewed.
The Escalation process is being audited, which means the team are looking at the types of escalation, common themes, and patient characteristics. A total of 151 transfers have been recorded. 20% of patients transferred to PCH are due to clinical deterioration.
Most parent interviews have been completed and the preliminary feedback includes that “Parent felt they could speak up and were listened to during their stay” and “Parents felt strongly about being involved with their child's care”.
We have received approval from the WA Aboriginal Health Ethics Committee to involve Aboriginal people as participants in our study and we will be inviting some parents of Aboriginal children to be interviewed.
Overall there is strong support for using one system across all paediatric health care that includes the composite scoring early warning tool. Further refinement will be required to optimise the PARROT for all settings.
The next steps for the project team include finalising the evaluations, reporting the results and making recommendations for the state-wide implementation of ESCALATION system.
.ESCALATION pilot and PARROT Chart Update
September was all about the sites trialling the escalation system. Education was rolled out to make sure everyone was familiar with using the charts. Over 23, 000 PARROT charts were delivered to the 6 sites.
The completion dates of the trial are:
The month of October is busy collecting data about the trial; chart audits, staff focus groups and parent interviews. A staff survey is next to be circulated by the pilot site managers and educators for all staff to give their feedback. Please contact us if you would like to directly provide feedback
via the contact us button
ESCALATION Project Team Update
The ESCALATION project team flew to Melbourne to attend the Australian and New Zealand Intensive Care Society - Safety and Quality Deteriorating Patient Conference (more information can be found on their websitehttps://www.anzics.com.au/safety-quality-conference/).
The Conference explored aspects of the deteriorating patient, more specifically, with the involvement of the family and the role of the patient in activation of the Medical Emergency team, recognising and responding to the deteriorating patient in the Emergency Department and measuring efficiency of the Rapid Response System.
The ESCALATION team presented a poster reporting the project (see photo). Associate Professor Fenella Gill was an invited speaker and discussed the role of the family/ Parent involvement in early recognition of the deteriorating child in hospital. The benefits of attending this conference were sharing our work more widely, gaining exposure to the clinical and scholarly area of current research and developments related to the deteriorating patient and to network with other clinicians and researchers in the area, establish contacts, and build collaborations.
photo- the ESCALATION project team and poster on display. From right to left Alannah Cooper, Pania Falconer, Associate Professor Fenella Gill and Professor Gavin Leslie
ESCALATION pilot and PARROT Chart Update
This month, has been all about getting the sites ready to pilot the PARROT charts and the escalation system. For the ESCALATION project we are in the implementation phase. The education has been rolled out to help with the implementation of the use of the charts. Charts have been delivered to the sites. Educators and staff are getting familiar with the charts. Over 300 staff have attended some training about this chart and the project. Education and training is still ongoing through September 2019.
On Monday the 12th of August, Pania (Nurse Educator/ ESCALATION Project Officer) flew down to meet staff at Albany Health Campus. The day was very successful as we met with over 50 clinicians and provided training for the implementation of the tool. The training was well received with positive feedback about the collaboration of the health services, the PARROT tool and the Escalation system. Pania met up with staff from the Emergency Department, the High Dependency Unit, the Medical ward and the theatre areas.
For all other sites, in preparation for the ward and ED settings, the Educators have been very busy decorating staff areas with posters to raise awareness for the use of the tool. Family posters are on display as well. During the pilot the sites will have ongoing support provided to them from the Escalation project staff.
The commencement dates of the Pilot sites are
ESCALATION project- July Update
PARROT Chart Update
The ESCALATION project team are very excited to say after two months of comprehensive consultation the 5 Paediatric Acute Recognition and Response Observation Tool (PARROT) charts are finally heading to the printers. This is a great achievement and significant milestone for the project. In two weeks’ time hard copies should be available. During the past two months, there have been over 50 Paediatric expert clinicians, researchers and Health consumers who provided constructive feedback about the chart. In addition, posters and flyers have been developed to promote the PARROT and family engagement. These will be displayed in the areas during the trial.
Training Day- PARROT
Acute clinical deterioration can happen at any point during a child’s admission to hospital. Evidence suggests in the hours before acute deterioration events such as cardiac arrest or unplanned admission to critical care paediatric patients show early signs and symptoms. This means there are opportunities to intervene early and prevent these events. The ESCALATION project has developed the Paediatric Acute Recognition and Response Observation Tool (PARROT) as an aid to the early warning system to improve early recognition and response to acute deterioration. This tool is to be trialled in WA health care settings in the coming months.
On July 4th 2019, 18 key educators and paediatric expert clinicians participated in a training day for the roll out of the PARROT with the ESCALATION project team.
The training day priorities included
Health Consumer Engagement
Parents play an important role in ESCALATION system, as they can sometimes notice vital changes in their child’s condition more quickly and easily than the health care team, which can lead to a quicker medical response. The ESCALATION project team have consulted with consumers in Broome, Bunbury and Perth. A survey had recently been circulated in electronic format via both Perth Children’s Hospital Facebook team and the Health Consumer Council network. The focus of the survey was to hear from consumers who have had their child admitted to hospital in Western Australia. Thank you to the Health Consumer Council and Perth Children’s Hospital for supporting the ESCALATION project and the survey.
Since our last post we have been working with designers on producing the new charts to be used at the six pilot sites. We have also been meeting with consumers to get feedback on educational materials around family involvement in the escalation process. Associate Professor Fenella Gill met with Be My Koorda which is a support group for aboriginal parents with children with autism and and/or other disabilities. Members of the support group provided valuable feedback which will help with developing materials for families.
Find out more about Be My Koorda
In the last month we have continued to make good progress with the project. The chart has been named the Paediatric Acute Recognition and Response Observation Tool or PARROT in short. The chart content and escalation process is currently being finalised and will be sent to designers soon. We also have both ethical and governance applications underway. Plans for education and implementation for each of our pilot sites Albany Health Campus, Broome Hospital, Fiona Stanley Hospital, Joondalup Health Campus, Narrogin Hospital and Perth Children’s Hospital are being developed. Broome Hospital will be the first site to trial the new chart and escalation process.
Since our last post we have made lots of progress with the project. We have been consulting with health care facilities, families, nurses and doctors across WA. This has included visits to sites in Perth, Bunbury and currently lead investigator Associate Professor Fenella Gill and Project Officer Pania Falconer are visiting the Kimberley. With the help of the working group the development of the escalation process and chart is well underway and six pilot sites have been selected which represent the diverse range of hospital services across the state:
-Albany Health Campus
-Fiona Stanley Hospital
-Joondalup Health Campus
-Perth Children’s Hospital
We aim to begin the pilot in June and have all pilot sites completed by the end of September.