We presented findings from the ESCALATION project so far at the Child Health Symposium which was held at Perth's Children Hospital from the 3rd-5th November. This annual event is jointly hosted by the Child and Adolescent Health Service and Telethon Kids Institute and brings together paediatric researchers to share their work. Please follow the link to view a copy of the poster presentation.
October 2020 Update
Testing of the ESCALATION system and second version of the Paediatric Acute Recognition and Response Tool (PARROT) is now underway at PCH and Broome. The system is being used at the Emergency Department, 2B medical and 2A at PCH and in the Emergency Department and Children’s Ward at Broome. All areas testing the ESCALATION System and PARROT will continue using this after the six week pilot.
The system will be implemented across PCH in February 2021 and will also be ready for state-wide implementation in 2021. Grant applications have been submitted to facilitate the implementation and evaluation of the ESCALATION system and PARROT.
August 2020 Update
For the first half of 2020 the project team has been working on the recommendations • Re-design and refinement of PARROT v2.0 using the evaluation findings and continued engagement with and input from stakeholders • Planning for the final testing of PARROT v2.0 prior to implementation • Planning for implementation of the ESCALATION system including PARROT v2.0. We are developing a comprehensive implementation and evaluation plan using Implementation Science Principles to ensure consistency and fidelity of use to optimise the system
From the feedback in 2019 we have redesigned the PARROT and implementation education tools
We are about to test the second version of the PARROT in two sites both PCH and Broome for 6 weeks (this will commence in mid- September 2020)
We are rolling out the implementation training and education now that includes a video
We will be collecting feedback at the end of the testing phase (November 2020)
Thanks to our staff in the Emergency Department, 2B respiratory and 2A who, together with staff from the Broome Hospital Emergency Department and Children’s Ward who have undertaken training and are using the ESCALATION System as part of this final stage of the testing. The new system is expected to be rolled out State-wide in the first half of next year
May 2020 Update
The ESCALATION project was successful in developing and trialing 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:
February 2020 Update
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:
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
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.
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.