ESCALATION project- December Update

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

• “Liked the A to E format and felt the prompts were appropriate”
• “Really liked having the respiratory distress tool on the back of the chart”
• “Liked that temperature wasn’t weighted felt this reduced false triggers”
• “Family / clinical concerns gets a score”

  Concerns

• Chart design- “Too busy, too much going on”
• Prefer to use the sedation score on separate chart/form

 
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. 
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Chart audits have been completed. A total of 249 charts have been reviewed.  
 Current themes

• Most used chart was the 1-4 year old PARROT
• Average of 5 sets of observations are recorded in 24 hours
• Modifications rarely used
• 20% had documented clinical/ family concern variable

 
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.