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Children in the emergency department deteriorate unexpectedly. Many paediatric sentinel events and coroner cases have recurring themes related to a parent’s/carer’s inability to effectively escalate their concerns about their child's deterioration while in the emergency department.  Early recognition of deterioration is fundamental for providing timely treatment and improving outcomes for children in the emergency department.


Improve the early recognition of deteriorating children in the emergency department. 


To co-design and implement effective tools for recognition, escalation, and response to the deteriorating child in the ED to:

  1. Improve parents’/carers’ confidence in recognising deterioration
  2. Provide clear communication pathways for parents/carers to escalate their concerns/worries
  3. Standardise the clinical response to parental escalation.

Outcome measure

There were zero paediatric sentinel events in the six pilot sites’ emergency departments between December 2021 and April 2022 with themes of parents/careers’ difficulty to escalate their concerns about their deteriorating child. 

Process measures

Between December 2021 (baseline) until April 2022, data was collected via parent/carer and staff surveys. Baseline data showed a high percentage of parent/carers already felt confident they knew the changes that meant their child was getting worse however fewer parents/carers understood their emergency department’s consumer escalation procedure.

Over the duration of this project, there was a sustained improvement in the percentage of parents/carers’ knowledge of the consumer escalation procedure and similarly there was also an increase in staff knowledge of their emergency department consumer escalation process. 


This project continued throughout the COVID-19 pandemic and declaration of a state-wide code brown. Despite this, the six pilot sites remained engaged and passionate about the project.

Whilst the project’s data collection numbers were small, the project’s monthly meetings provided opportunity for the consumers’ voices to be listened to and heard, and for clinicians to share their learnings. During these sessions, we also became aware that there was no ‘one size fits all’ approach. Each pilot site faced unique challenges – from geographical barriers to language barriers to staffing barriers – that needed to be addressed via the development of their own change ideas. All sites benefited from the inclusion of consumers in their project teams, who were key to the development and testing of change ideas.

At the conclusion of this project, pilot site representatives were keen to continue to collaborate and partner with their consumers to help improve the early recognition of the deterioration child in their emergency department.

Watch the final presentation including a discussion with the project’s Clinical Lead and 5 minute overviews from each clinical site explaining their change ideas and learnings.

After the project ended, consumers, clinicians from the pilot sites and other health services across the State met virtually to share their learnings and initiatives to improve parental escalation of care in EDs.

Watch the discussion session from 13 September 2022.

Discussion held on Tuesday 8 November 2022 regarding improved parental escalation of care in an emergency department.

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