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edadmin:escalation

escalation, notification, communication in the ED

Introduction

  • communication, notifications and escalations of issues are critical components to safe delivery of effective healthcare in the emergency department
  • care however must be given to ensure these processes do not become too complex, too time consuming or contribute to unnecessary cognitive overload
    • the recipient of any escalation notification should be clearly aware whether this is just an information notification (FYI) so that they are aware, or, it is for THEIR PERSONAL ACTION

Communication and escalation within the ED

general clinical processes

  • allocation of triage clinical urgency
  • documentation of critical clinical details including alerts such as:
    • allergies
    • infectious risk
    • absconding risk
    • security risk
    • falls risk
    • language issues
  • junior doctor clinical review by senior doctor
    • soon after assessment to ascertain the optimum investigation, management and disposition strategies
  • clinical handover
  • patient-initiated nurse call system
  • patient-initiated “call for help” systems
  • bedside emergency call system and response team
  • nurse-initiated MET criteria abnormal vital sign escalation process
  • nurse-initiated behaviour of concern (BOC) notification process
  • order request documentation eg. request to have bloods or swabs taken, internal consults
  • regular team huddles

Communication and escalation from the ED to managers or external services

usual clinical processes

  • Trauma calls
  • Stroke calls
  • STEMI calls
  • Code Blue, etc
  • order request documentation eg. request to have radiology
  • discharge letters to GPs
  • referrals to inpatient teams, language services and outpatient requests
  • requests for security attendance for a pending patient arrival who is a security risk

routine reporting

  • regular huddles (perhaps 4 hourly) to escalate current status and issues and to look for opportunities to problem solve and address issues early
  • these could be structured and routinely convey information such as:
    • General ED patient status parameters:
      • Number of patients in the ED
      • Number waiting to be seen by a doctor
      • Number waiting to be seen by a doctor more than x hours
      • Number patients presenting in past 2hrs
      • Maximal wait time
      • Number of ambulances waiting to offload and the maximal time waiting
      • Number of bed requests allocated ward beds vs not yet allocated and critical care / mental health admits
      • Number of patients mechanically restrained or intubated or requiring NIV
      • Short Stay Unit occupancy, numbers awaiting admission to the SSU, number of SSU patients awaiting a non-SSU ward bed or transfer out
    • General staffing parameters
      • this may be a traffic light system
    • Quality and safety issues
      • this may be a traffic light system
    • Environmental issues
      • this may be a traffic light system

ad hoc reporting

  • emergent security events
    • Code Grey
    • Code Black
    • duress alarms
  • adverse event documentation and notification systems
    • eg. software such as Riskman
  • system issue escalation and notifications
    • quality and safety
      • staff safety and experience
      • patient safety and experience issues
        • patient bed access / ED overcrowding issues
          • access block
          • ambulance ramping
          • excessive wait times
        • deaths in the ED
        • ISR 1 or 2 incidents
        • notable other incidents or near misses
        • absconding patients
      • legal matters
      • media requests and involvement
      • other issues of concern of which managers should be made aware
    • workforce issues
      • unexpected leave
      • staffing deficits
    • environmental issues
      • physical infrastructure
      • equipment and stores
      • ICT

Communication and escalation to the ED from external services

usual clinical processes

  • notification of patient expect
    • from GPs or other providers
    • from ambulance or police services
    • from wards or a hospital Code Blue response for a non-admitted person
  • time-critical investigation results
    • phoned through to ED
  • other abnormal investigation results
    • various notification and sign off mechanisms
  • in-coming calls from inpatient teams responding to referrals
    • these may trigger an internal ED microphone communication to call the staff member to the phone if the individual staff member does not carry a phone for these purposes or is unable to answer it (performing a procedure, wearing PPE, etc)

routine reporting

  • regular hospital Exec - HOU huddles / forums

ad hoc reporting

  • notification of special circumstances
    • outages or service reductions
    • Emergency Code system - eg. Code Red
    • potential infectious disease outbreaks eg. Legionella, measles
  • process change notifications
edadmin/escalation.txt · Last modified: 2020/08/30 23:36 by gary1