Evaluating the Scale‐Up and Sustainability of the Paediatric ESCALATION System in Country Western Australia: A Multi‐Methods Study.
Objective: To identify factors influencing implementation and integration of the paediatric ESCALATION system in country Western Australia. Setting and Participants: Health professionals (nurses and doctors) working in country Western Australia. Design and Methods: A multi‐methods study using an int...
| Publicado en: | Australian Journal of Rural Health Vol. 34; no. 4; pp. 1 - 16 |
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| Autores principales: | , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
Aug2026
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=196480569&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 196480569 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10385282 FQO jtl: Australian Journal of Rural Health issn: 10385282 maglogo: Y pubinfo: dt: Aug2026 vid: 34 iid: 4 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 196480569 196480569 196480569 10.1111/ajr.70229 196480569 ppf: 1 ppct: 15 formats: tig: atl: Evaluating the Scale‐Up and Sustainability of the Paediatric ESCALATION System in Country Western Australia: A Multi‐Methods Study. aug: au: Boyle, Eileen Laird, Pamela Leslie, Gavin D. Stokes, Scott Andrew, Jenni Howard, Jon Robinson, Melanie Harris, Tania Gill, Fenella J. affil: Faculty of Health Sciences, School of Nursing, Curtin University, Perth Western Australia,, Australia sug: subj: Pediatrics Western Australia Patient Safety Clinical Deterioration Health Personnel Psychosocial Factors Program Implementation Psychosocial Factors Program Evaluation Implementation Science Western Australia Human Male Female Adult Middle Age Aged Multimethod Studies Descriptive Research Convenience Sample Purposive Sample Focus Groups Interviews Thematic Analysis Systems Integration Early Warning Score Confidence Decision Making, Clinical Teamwork Communication Rural Health Services Adult: 19-44 years Middle Aged: 45-64 years Aged: 65+ years Male Female ab: Objective: To identify factors influencing implementation and integration of the paediatric ESCALATION system in country Western Australia. Setting and Participants: Health professionals (nurses and doctors) working in country Western Australia. Design and Methods: A multi‐methods study using an interpretive descriptive approach guided by the Practical Robust Implementation and Sustainability Model (PRISM) and Normalisation Process Theory (NPT). Data collection across six sites included patient chart audit, health professional survey and focus groups/interviews. Data were analysed descriptively (audit and survey) and thematically (focus groups/interviews). Results: An audit of 94 patient charts showed 61.7% met escalation of care criteria, while 69.0% of cases were escalated per policy. Among 114 survey responses, findings indicated system integration, with 95.6% reporting ESCALATION was part of their role, 93.5% agreeing it supported early detection of clinical deterioration and 93.8% reporting ease of use. Fewer identified local champions (66.7%), had confidence in others' use of the system (61.1%), reported sufficient training (69.0%), or were aware of reports demonstrating system effectiveness (55.0%). Seventy‐eight health professionals participated in focus groups/interviews. Three themes were interpreted through the PRISM and NPT frameworks: (i) Enhanced patient safety (intervention characteristics and participants' perspectives; coherence; cognitive participation), (ii) Strengthening clinical decision‐making (implementation and sustainability infrastructure; cognitive participation; collective action), (iii) Monitoring and fidelity (implementation and sustainability infrastructure, external; collective action; reflexive monitoring). Conclusion: The paediatric ESCALATION system is embedded and valued, but sustaining fidelity through scale‐up requires ongoing training, teamwork, confident communication and organisational support across regional, rural and remote WA health services. Summary: What Is Already Known on This Subject? ○Early warning systems like the paediatric ESCALATION system are designed to support timely recognition and response to clinical deterioration in hospitalised children to enhance patient safety.○The long‐term sustainability of the Western Australian paediatric ESCALATION systems depends on addressing implementation challenges, including variability in practice, staff engagement and training needs in regional, rural and remote healthcare services.What Does This Paper Add? ○Health professionals view the paediatric ESCALATION system as a valuable and user‐friendly tool that enhances early recognition and response to clinical deterioration, empowering nurses to escalate care effectively.○This study highlights that scale‐up and acceptance of the paediatric ESCALATION system do not automatically translate into high‐fidelity use in regional, rural and remote WA healthcare settings. Targeted education, local leadership and system‐level support are important for maintaining system fidelity across diverse clinical settings. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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