Serious deterioration in a patient’s physical, mental or cognitive health may occur at any time. In some circumstances, healthcare providers may observe this change while delivering health care and be required to assist. In these instances, healthcare services should have a process for healthcare providers to:
- Respond appropriately to a patient within their scope of clinical practice. For instance, the assistance that a physiotherapist may provide may differ from the assistance a nurse practitioner is able to provide, and will be dependent on the support, equipment and service offering of the healthcare service
- Call for emergency assistance. In most instances this would be for an ambulance service; however, it may include direct transfer arrangements or emergency consultation with specialist healthcare providers based on formal or informal partnerships
- Notify other relevant healthcare providers, carers and family members.
Establishing processes to respond to serious deterioration and escalation of care and calling for emergency assistance will ensure healthcare providers can respond consistently and effectively. The mechanisms need to be appropriate for the size and location of the healthcare service and the population it serves. Other considerations include the available resources, healthcare provider skills mix and capacity to engage specialist help.
Multiple mechanisms may be necessary in escalation systems to allow different responses to varying levels or types of deterioration. These mechanisms may include:
- Landline phones
- Mobile or satellite-navigation phones
- Two-way radio devices
- Dedicated mobile, on-call and emergency telephone numbers.
- Distance and location of response services (ambulance or aerial medical service) providers
- Mechanisms that can assist the response service to locate the patient
- Backup systems or processes in the event of equipment failure
- Processes for maintaining any relevant equipment
- Training on the processes for escalating care, including for new, casual, locum, and agency members of the workforce.
In rural and remote community settings it may be helpful to develop processes for obtaining emergency advice from specialist providers - such as ambulance, aerial medical services, general practitioner, emergency or mental health services, or intensive care clinicians - by phone, video link, or two-way radio.