Update February 2020

Project summary
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:

1. Literature review, benchmarking, stakeholder and community consultation resulting in the development of the ESCALATION System; an evidence based early warning tool and an escalation pathway. The Paediatric Acute Recognition and Response Observation Tool (PARROT) consists of a suite of five age-specific track and trigger charts with ten weighted variables. The PARROT is the first early warning tool to incorporate clinical assessment, clinician and family concern, an escalation process, and a clinical communication model focusing on timely action
2. Trial of the ESCALATION System to examine a) the feasibility and acceptability of the ESCALATION System and b) factors necessary to ensure successful implementation. The six pilot sites were: Perth Children’s Hospital, Fiona Stanley Hospital, Joondalup Health Campus, Broome Hospital, Albany Hospital, Narrogin Hospital.
3. Evaluation included audits, surveys, focus groups and interviews. Feedback was positive from staff and consumers. There is strong support for using one system across all WA paediatric health care settings. This includes using the PARROT in all WA paediatric services (Emergency Departments (ED) and wards).

The project recommendations are for state-wide implementation following:

• Some refinements to optimise the PARROT chart design

• Final testing of the PARROT in clinical practice will then confirm that we have the optimum version of the PARROT suitable for large scale implementation.