ArticleBMJ quality & safety2024
Understanding the enablers and barriers to implementing a patient-led escalation system: a qualitative study.
Article in BMJ quality & safety, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 2 of them syntheses that pooled it.
What it found
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Who cites it
5 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Patient and family activated escalation systems: a systematic review.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2026Pooled it
- What Is Known About Family-Inclusive Inpatient Care From Patient and Family Perspectives? An Integrative Review.Journal of advanced nursing · 2025Pooled it
- Trauma handover practices between ambulance clinicians, emergency department staff and trauma teams: scoping review.BMC emergency medicine · 2026Article
- Still just the nurse? A critical inquiry into nurses' struggles for autonomy in interprofessional hospital teams.BMC nursing · 2025Article
- Implementing clinical practice guidelines into action: a qualitative study of managing knowledge translation in primary care organisations.Health research policy and systems · 2025Article
Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe management of acute deterioration following surgery remains highly variable. Patients and families can play an important role in identifying early signs of deterioration but effective contribution to escalation of care can be practically difficult to achieve. This paper reports the enablers and barriers to the implementation of patient-led escalation systems found during a process evaluation of a quality improvement programme Rescue for Emergency Surgery Patients Observed to uNdergo acute Deterioration (RESPOND).
methodsThe research used ethnographic methods, including over 100 hours of observations on surgical units in three English hospitals in order to understand the everyday context of care. Observations focused on the coordination of activities such as handovers and how rescue featured as part of this. We also conducted 27 interviews with a range of clinical and managerial staff and patients. We employed a thematic analysis approach, combined with a theoretically focused implementation coding framework, based on Normalisation Process Theory.
resultsWe found that organisational infrastructural support in the form of a leadership support and clinical care outreach teams with capacity were enablers in implementing the patient-led escalation system. Barriers to implementation included making changes to professional practice without discussing the value and legitimacy of operationalising patient concerns, and ensuring equity of use. We found that organisational work is needed to overcome patient fears about disrupting social and cultural norms.
conclusionsThis paper reveals the need for infrastructural support to facilitate the implementation of a patient-led escalation system, and leadership support to normalise the everyday process of involving patients and families in escalation. This type of system may not achieve its goals without properly understanding and addressing the concerns of both nurses and patients.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.