Mr. Jason Belcher1,2, Mr. Earl Beech1, Prof. Fenella Gill2,3
1St John Western Australia, Belmont, Australia, 2Curtin University, Bentley, Australia, 3Child and Adolescent Health Service, Nedlands, Australia
Biography:
Biography to come.
Abstract:
Background: Family or caregiver concern is highly predictive of paedriatic patient deterioration, particularly children with sepsis who may not initially present with overt priority symptoms. While this is well recognised cognitively, there has never been a systematic method of capturing concern to trigger action. St John WA, in collaboration with tertiary paediatric services, developed a statewide ESCALATION System for recognising and responding to clinical deterioration.
Actions: The ESCALATION System incorporating the Paediatric Acute Recognition and Response Observation Tool (PARROT) was introduced into prehospital care in WA for paediatric patients in October 2023. The system provides an observation-based early warning score (EWS), and crucially allocates family or clinician concern one point in the EWS. A prehospital sepsis screening tool was also introduced, with family concern being one of the triggers to start a sepsis assessment for a paediatric patient.
Results: Acceptability and feasibility were assessed through feedback collected during paramedic education about the system and review of patient care records. Paramedics embraced ESCALATION, and now report more proactively asking about family concerns. An audit in the first four months of introducing ESCALATION shows family concern field was completed in 79% of cases. The PARROT EWS score which highlights patients of concern is visible to hospitals and senior paramedics statewide via SJWA’s Ambulance Live Dashboard.
Conclusion: Use of an early warning and screening system that integrates family concern in a systematic way has promising potential to improve patient safety. Once validated in the prehospital environment, ESCALATION could be rolled out nationally.