Safe system framework - 4: Responding to deterioration

Responding to deterioration

A timely and accurate response - encompassing all necessary support and treatment - from all those involved in the care of the patient is vital. It is often the key change that is needed.


Children, families and carers

  • Involvement in individualised care decisions
  • Communication protocols, standards or principles with patients and families

Clinicians and wider team

  • Structured communication model for escalation, such as SBAR, and local response protocols (such as review, rapid response teams, medical emergency teams and transfer)
  • Awareness of negative attitudes towards escalation that may be downgraded on review
  • Clear plans for treatment/clinical monitoring and review
  • Knowledge and use of situational awareness
  • Good clinical pathways for condition specific responses such as mental health needs and children with complex medical needs
  • Discharge/ transfer protocols

Service or organisation 

  • Availability of working equipment for taking physical observations
  • Leadership at all levels to support the responsibilities of the clinicians and wider team in recognising the deteriorating child, including evidence of good practice and actions for improvement

Regional, national, networks

  • System-wide knowledge and thinking on the gaps, research and debate in this area including support for the publication and recommendations for action when evidence becomes available


SAFE resource pack - especially sections on using structured communication and the huddle; examples of clinical escalation and SBAR documentation

Resources to support the prompt recognition of sepsis and the rapid initiation of treatment (including Paediatric Sepsis Six and other UK Sepsis Trust resources)

Peadiatric Care Online (PCO UK) supports daily clinical practice by providing immediate, accessible information to inform decisions at point of care

MedsIQ brings together tools and improvement projects that have been developed to address medication errors affecting children and young people

ReACT parent films (“If you see something, say something”) created for parents, and for staff supporting and empowering parents and families, including:


Just Say Sepsis! (2015) National Confidential Enquiry into Patient Outcome and Death (NCEPOD)

NHS England Improving outcomes for patients with Sepsis: a cross-system action plan

NHS England Patient Safety Alert – resources to support the prompt recognition of sepsis and the rapid initiation of treatment

UK Sepsis Trust clinical toolkits

CP Bonafide, A Localio, KE Roberts, VM. Nadkarni, CM Weirich and R Keren (2014). Impact of Rapid Response System Implementation on Critical Deterioration Events in Children. JAMA Pediatr; 168(1):25-33. doi:10.1001/jamapediatrics.2013.3266. Published online November 11, 2013.

PE Schmidt,P Meredith, DR Prytherch, D Watson,V Watson, RM Killen, P Greengross, MA Mohammed, GB Smith (2014) Impact of introducing an electronic physiological surveillance system on hospital mortality. BMJ Qual Saf 2014;0:1–11. doi:10.1136/bmjqs-2014-003073

G Sefton, C. McGrath, L. Tume, S. Lane, P.J.G. Lisboa, E.D. Carrol (2014) PICU, What impact did a Paediatric Early Warning system have on emergency admissions to the paediatric intensive care unit? An observational cohort study. Intensive Crit Care Nurs (2014)