November 2024 Update
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PictureL-R Miss Arizona Galbraith and Dr Eileen Boyle
Research Programs Progress
Data collection has reached significant milestones across the 4-sub-studies within the research program:

 1. Embedding and Sustaining the ESCALATION system in WA Country Health Service
We have completed Stage 1 data collection in six hospitals in WA Country Health Service including Bunbury, Broome, Geraldton, Narrogin, Carnarvon, and Karratha.  One hundred and seven nurses and doctors completed an online survey and 78 participated in focus groups. We hear that the ESCALATION System’s Paediatric Acute Recognition and Response Observation Tool [PARROT] is seen as helpful in child assessment and recognising early deterioration "I think that it is helpful. I think the simplicity of the chart, following it through, looking for other causes of tachycardia and other things like that is really important. I like that.” [Focus Group 15, Nurse]
 
In Stage 2, we will collaborate with our research team and community reference group to discuss our findings and enhance how health professionals use the ESCALATION system.

 2. Family involvement in the ESCALATION System at Perth Children’s Hospital
All data collection and analysis is completed. We are in the process of preparing two papers for publication. One paper will focus on the family experiences of engaging with health professionals when worried about their child’s health the other will focus on how health professionals involve families in the ESCALATION System. Findings have informed refinement of family involvement wording for version 5 which will be rolled out in January 2025.

2. Aboriginal Family involvement in ESCALATION System
Thirty Aboriginal families participated in interviews sharing their experiences of speaking up when worried about their child’s health when in hospital. Seventy-two health professionals (nurses and doctors) participated in focus groups sharing their experiences of involving Aboriginal families in the ESCALATION system. We hear that Aboriginal families are more likely to speak up when they feel safe and supported in a culturally respectful environment: "Especially for Aboriginal people, you start talking about family, they see you as being real, not somebody who's just sitting here doing a job. In terms of cultural awareness, if you start talking about family, and you start opening up about your family, you will find that Aboriginal people will probably be a bit more respectful and open with you. " [Participant 07, Grandmother]
 
We are now in Stage 2 of the project, recruiting Aboriginal families, health providers, and community leaders to participate in community-based working groups. These groups will work collaboratively with the research team to co-design solutions to enhance Aboriginal family involvement in the ESCALATION System.

4. Predicting clinical deterioration using the ESCALATION System
We have gathered data from 643 cases (exceeding our minimum sample size of 450 cases). We will complete cases data collection in December and have commenced data collection on matched controls.

Conference presentations
The research team has been promoting the research program studies and PhD progress and reporting preliminary findings:

November: Child Health Research Symposium
The Child and Adolescent Health Service, Child Health Symposium Empowering Futures: Advancing Child Health was held in Perth the 4th-8th of November. It highlighted the range and quality of child health research being conducted across Western Australia and the interdisciplinary nature of our research workforce.

Dr Eileen Boyle and Miss Arizona Galbraith presented preliminary findings of the Aboriginal family experiences of involvement in the ESCALATION system.  

​Overall study findings describe the key role families play in recognising when their
child is unwell in hospital and Aboriginal Families are more likely to speak up
about their worries when they feel culturally safe.  
PictureL-R Mrs Tania Harris, Miss Lizzy Harris, Professor Fenella Gill, Ms Melanie Robinson, Dr Eileen Boyle and Dr Esther Adama
​Professor Fenella Gill presented findings on family involvement in the ESCALATION System at Perth Children’s Hospital. She highlighted that families appreciate their role and feel comfortable voicing their opinions in a supportive and encouraging environment.


​Dr Esther Adama presented the health professional experiences with family involvement in the ESCALATION System. She emphasised that they recognise the importance of integrating family involvement into the ESCALATION System. 
PictureChelsea Kelly presenting at the conference
​Chelsea Kelly presented the preliminary findings of health professionals'
(nurses and doctors) experiences of assessing signs of clinical deterioration in children with dark-coloured skin at the Aboriginal Health, Early Intervention and Prevention session. Chelsea has completed focus groups and interviews with 99 health professionals overall, with data analysis in progress.

Chelsea also presented her PhD “Creating a framework to support nurses’
detection of clinical deterioration in children with dark-coloured skin” in
the nursing satellite session.

​Chelsea is supported by the WA Future Health and Research Innovation Fund, and more recently has gained the invaluable support of the Australian College of Children and Young People’s Nurses through their Dorothy Clarke Scholarship and the WA Department of Health Chief Nursing and Midwifery Office through their Academic Research Grant.
September: Curtin School of Nursing Fifty Years of Excellence Conference

The Curtin School of Nursing “Celebrating Achievements, Envisioning the Future: A Journey of Excellence in Nursing, Midwifery, Paramedicine and Oral Health Therapy” was held in Perth on the 5th and 6th of September. The conference brought together healthcare providers, practitioners, regulators, policymakers, academics, and researchers’ opportunities to share practices, leadership ideas and knowledge. Professor Fenella Gill and PhD candidate Sarah Rooney chaired the ‘Escalating care’ session on Friday, September 6th.

Dr Esther Adama and Professor Fenella Gill presented the findings on health professional and family Experiences respectively from the Family involvement in ESCALATION System study at Perth Children’s Hospital.
 
Professor Fenella Gill and Miss Arizona Galbraith presented preliminary findings of the  Aboriginal family experiences of involvement in the ESCALATION  system.
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L-R: Ms Melanie Robinson, Director Aboriginal Health, Child and Adolescent Health Service, Dr Esther Adama, Professor Fenella Gill, Dr Maggie Zgambo, Ms Arizona Galbraith, Dr Jo Zhou
PictureL-R: Professor Fenella Gill, Chelsea Kelly and Emeritus Professor Gavin Leslie
​Chelsea Kelly presented an overview of findings from her scoping review of the
literature on the assessment of clinical deterioration in children with dark-coloured
skin in a scientific poster format. Chelsea passed her PhD Milestone 2 in September
and her PhD is on track.




​Major Milestone Achieved
Sarah Rooney’s PhD study has achieved two major milestones. The research study received ethics approval through the Child and Adolescent Health Service, South Metropolitan Health Service, and Curtin University Ethics Committee. Sarah has commenced data collection for her Retrospective Cohort Study to describe the incidence, causes, and outcomes of Medical Emergency Team and Patient and carer-activated escalation of care events among Culturally and Linguistically Diverse patients. Sarah also passed her PhD Milestone 2 in November and her PhD is on track.
 
Consumer and Community Advisory Group
The Consumer & Community Advisory Group met on Tuesday, August 13th, and was attended by 5 members. The meeting focused on reviewing the progress and findings of the studies. Professor Fenella Gill presented the proposed changes to Version Five of the Paediatric Recognition and Response Observation Tool (PARROT), adding an assessment of mental state changes.   

Maggie Harrigan updated the progress of Project 5-co-designing an online tool for families to escalate here. Grant applications have been submitted to support the development of the tool and an application to the Child and Adolescent Health Service Ethics Committee is in progress. Chelsea Kelly updated the committee on her PhD.

July 2024 Update

​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]
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​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.
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Professor Fenella Gill presenting at the congress.
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International congress delegates.

April 2024 Update

We are well underway with data collection across 4 sub-studies within the research program. ​
PictureDr 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.
PictureL-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. 
PictureDr 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. ​
PictureMaggie 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. 
PictureProfessor 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". 
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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.
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