Co-Designed Approach to Respond to Paediatric Clinical Deterioration

A system which improves the recognition of and response to clinical deterioration in hospitalised children is being rolled out across Western Australia as a result of a project by the Western Australian Health Translation Network (WAHTN).

“Failure to detect and act on signs of clinical deterioration in a timely manner can result in serious adverse outcomes with devastating results, particularly in children,” said Associate Professor Fenella Gill, who in 2019 received an Early Career Fellowship in Translational Health Research from WAHTN.

Dr Gill, who is an Associate Professor in Acute Paediatrics, a joint appointment at Curtin University and Perth Children’s Hospital, dedicated herself to addressing the lack of a state-wide approach to addressing clinical deterioration.

She led co-production of a system named ESCALATION with a working group that included nurses, doctors, health consumers and a human factors principles expert.

The ESCALATION System was piloted at six hospitals across metropolitan and regional WA.

“The trial system was well received by both staff and families, with feedback provided to further fine-tune prior to full implementation,” said Dr Gill.

A/Prof Fenella Gill with one of her patients at Perth Children’s Hospital

Involving families and empowering parents and guardians in their children’s care is a key component of the ESCALATION System.

“Parents know best what is normal or not about their child and by including them in assessment of their child and encouraging them to voice their concerns about any changes to staff, we can reduce adverse outcomes,” said Dr Gill.

“Consultation with families confirmed they wanted information on posters to be displayed in patient rooms to assist families in initiating a dialogue with nurses or doctors if they were concerned about clinical deterioration.”

The resulting resources explained what signs to look out for and encouraged families to raise concerns with staff.

One year on from the end of the Fellowship program, ESCALATION Version 3.0 (which includes sepsis prompts and a sepsis escalation pathway) has now been implemented at Perth Children’s Hospital and Broome Hospital. State-wide implementation is being coordinated through the WA Department of Health.

Dr Gill says the support of WAHTN through the Fellowship program was key to the successful engagement of stakeholders across the state.

“This Fellowship enabled the project to be undertaken using a coordinated, systematic and collaborative approach,” said Dr Gill. “This resulted in all stakeholders agreeing to implement the ESCALATION System which will mean that for the first time there will be a uniform standardised system with integrated family involvement in place in WA.”

Although the project has been a great success, Dr Gill does not intend to stop there. Her focuses now include adapting the system to be culturally appropriate for the involvement of parents and families of Aboriginal children and families with ethnolinguistically diverse backgrounds , conducting simulation research to improve use of the system by health professionals, measuring effectiveness of the system, and evaluating implementation across the state to ensure fidelity and sustainability.

As well as contributing to improvement of paediatric practice in WA hospitals, the Fellowship program played an important role in the professional development of Dr Gill.

“I gained invaluable experience in leading a research team, working across health services and navigating multiple research ethics and governance processes,” said Dr Gill. “The project enabled me to strengthen collaborative relationships with key stakeholders in health services, organisations and consumer groups.”

More information on this project is available at

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