ESCALATION system

The ESCALATION system is a series of clinical pathways for early recognition and response to clinical deterioration in paediatrics.

The system includes:

Paediatric Acute Response and Recognition Observation Tool (PARROT)

The PARROT is an age specific track and trigger chart that includes indication of family concern, and escalation of care pathways fully integrated into the tool. The following observations and symptoms must be completed to obtain an accurate EWS at the time of initial presentation/admission to an area and as appropriate for the patient’s clinical condition:

• Respiratory distress score
• Respiratory rate calculated over 1 minute
• Oxygen saturation % (SpO2)
• Oxygen therapy score
• Heart rate calculated over 1 minute
• Blood pressure
• Capillary refill time
• Pain scale score
• Level of consciousness using AVPU (alert, voice, pain, unresponsive)

Note: Whilst temperature is not included in the EWS, a baseline temperature recording is taken on admission and four hourly thereafter for an inpatient if within normal limits.

As of September 2022, there is now statewide implementation of the PARROT EWS Chart across all WA Health hospitals.

Early Warning Score (EWS)

The Early Warning Score is a number which triggers a clinical response on the Escalation Pathway. Any observation or symptom that falls within a coloured area on the chart will add a number to the total EWS to prompt the clinical response.

Sepsis Pathway

Time is crucial in the effective treatment of sepsis so early recognition and escalation of care is vital.

To support clinicians in the hospital setting caring for children, the ESCALATION system includes a Paediatric Sepsis Recognition Escalation Pathway on the Paediatric Observation and Response Chart (PARROT Chart). This Pathway is used alongside Early Warning score (EWS) when measuring vital signs and other clinical observations. The Pathway includes information about when to consider sepsis, information about patients who are at higher risk of sepsis, and clear information on the response required.

If a patient requires a Sepsis Review clinicians will then commence the PCH Sepsis Pathway.

The PCH Sepsis Pathway is a screening, escalation, assessment and management tool and a clinician decision support tool.

It identifies a child with features of severe illness and empowers staff to escalate to a senior doctor who can then recognise if it is sepsis or not.

The PCH Pathway is also an assessment tool, with treatment and post resuscitation guidelines.

Recognising concerns