Escalation System in Clinical Practice

Escalation System in the Clinical
Practice

Table of Contents
Introduction......................................................................................................................................1
Methods............................................................................................................................................1
Critical Analysis...............................................................................................................................1
Article 9: Decrease in Inpatient Telemetry Utilization Through a System-Wide Electronic Health
Record Change and a Multifaceted Hospitalist Intervention...........................................................6
Summary of the Literature...............................................................................................................7
Recommendations for further Research and Practice Implications.................................................7
References........................................................................................................................................9
Appendices.....................................................................................................................................11

Introduction
Escalation system refers to an effective process which helps to move complaints or concerns of
client directly to more senior representative or one who initiated the relevant procedure. It
includes the set of two categories of escalation such as hierarchical and functional from which
suitable one is adopted by healthcare organisation to respond feedbacks of patient effectively.
However, this can be considered as an effective system that should be used in clinical practices
so that complaints of patient can be addressed as soon as possible (Ganasegeran, Renganathan,
Rashid and Al-Dubai, 2017). It will facilitate to deliver appropriate care services by improving
clinical procedures in order to satisfy patients by resolving their concerns effectively. In context
of this project, it is based on the topic of escalation system in clinical practices including its
support in healthcare organisation. This assignment will focus in critical analysis of relevant
articles along with discussing used methods. It will also include the summary of literature related
to escalation system in clinical practices and recommendations for the same.
Methods
There are mainly two types of data collection methods that is used by researcher in order to
investigate on particular topic that is primary and secondary method. For the present research,
secondary data collection method is used that include journal papers, newspaper, articles, books
and many more. It is analysed that collecting secondary information is cost effective and easily
available for researchers. In the present research, 12 articles is used and analysed in order to gain
knowledge about particular topic in a proper manner.
Critical Analysis
Article 1: Factors that might impact intrathecal drug delivery (IDD) dose escalation: A
longitudinal study
Considering selected article, it has been analysed that IDD system with implantable pumps can
be utilised for treating cancer related pain and non-cancer related chronic pain. It includes the
utilisation of opioids such as morphine and hydromorphone that are generally used intrathecal
agents. It is observed that dose escalation increase rapidly in non-cancer pain among people by
use of technology and advanced techniques (Mekhail, Mahboobi, Farajzadeh Deroee, Costandi,
Dalton, Guirguis and Mehta, 2020). However, it has been founded that median dosage escalation
has figure of 17% every year for patient suffering from neuropathic pain as compared to 12 % of
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people having other pain modalities. Moreover, it includes the fact that people with neuropathic
pain indicates annual increase about daily use of opioid dose as compared to people with
different pain modalities.
Article 2: Management of benzodiazepine-resistant alcohol withdrawal across a healthcare
system: Benzodiazepine dose-escalation with or without propofol
As mentioned above, it has been identified that severe cases of alcohol withdrawal syndrome
(AWS) may not resolve despite escalating doses of benzodiazepines (BZDs). It includes the
benzodiazepine-resistant alcohol withdrawal (RAW) can be considered as subset of severe
alcohol withdrawal defined by the need of more than or equal to 40 mg of diazepam. The review
of adult patients was carried out with RAW in which that were categorised into BZD dose
escalation or BZD plus propofol. It has been founded that the severe AWS condition was
identified among around 1083 participants and 66 RAW patients were evaluated who met
inclusion (Wong, Benedict, Lohr, Pizon, and Kane-Gill, 2015). It is observed that the median
time was examined to AWS resolution was 5.0 whereas 7.0 days for BZD vs. BZD plus
propofol. However, it has been evaluated that escalation related to this medications is observed
which is helpful for healthcare practitioners to increase effectiveness of providing dosage in
order to reduce relevant problems in clinical practices.
Article 3: A call for better doctor–nurse collaboration: A qualitative study of the
experiences of junior doctors and nurses in escalating care for deteriorating ward patients
By considering selected article, it has evaluated that implementation of medical emergency
teams (METs) in hospitals for providing immediate interventions for their wellbeing. It is
necessary for healthcare professionals to focus on effective clinical practices for delivering better
quality of services for patient’s wellbeing. Meanwhile, it is observed that junior doctors and
nurses escalate for deteriorating ward patients in healthcare organisation with formulated MET
services. The emergency situations in health may occur anytime when professional re required to
take immediate action then possibility of mistakes takes place. It is required for healthcare
management authority to train the staff for increasing accuracy of care practices.
In addition to this, it has been founded that the experience of doctors and nursing staff influence
the escalation which should be responded as soon as possible for authorised person for client
concerns. The group of participants has 24 individuals including 10 junior doctors and 14
registered nurses working in general hospital in MET services (Chua, Legido-Quigley, Jones, D.,
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