Impact of implementing a patient and carer escalation system for clinical deterioration in general wards: A...

To consolidate evidence on the impact of implementing a patient and carer escalation system.

Six electronic databases (MEDLINE (OvidSP), CINAHL, Embase, PsycINFO, Scopus, and Web of Science) were searched from 01 January 2012 until 26 May 2024. Two reviewers independently screened articles that reported on the implementation and evaluation of patient and carer escalation of care system. The Critical Appraisal Skills Programme tool, Joanna Briggs Institute critical appraisal tools, and the Mixed Methods Appraisal Tool were used to appraise the quality of the included studies. A convergent integrated synthesis approach and thematic analysis were adopted for data synthesis.

Eighteen studies are included in this review. Five main themes emerged from the data analysis: (1) enhanced patient safety versus burden on patients and carers; (2) forging partnerships between healthcare professionals, patients and carers; (3) empowerment of patients and carers; (4) perception of professional competence being questioned and undermined; (5) potential strain on healthcare resources. Enhancement of patient's safety was found to be the prominent result of this review followed by the demand in resources to improve the implementation of patient and carer escalation systems.

This review illustrates the growing interest in implementing patient and carer escalation systems to empower patients and carers to escalate clinical concerns in hospitals.

Successful implementation of patient and carer escalation systems is necessitated by the integration of formal education for healthcare professionals, patients and carers. Further high-quality research to develop the metrics of patient and carer escalation system effectiveness is warranted.