Why do healthcare professionals fail to escalate as per the early warning system (EWS) protocol? A qualitative evidence synthesis of the barriers and facilitators of escalation

Abstract Background Early warning systems (EWSs) are used to assist clinical judgment in the detection of acute deterioration avoid or reduce adverse events including unanticipated cardiopulmonary arrest, admission intensive care unit and death. Sometimes healthcare professionals (HCPs) do not trigger alarm escalate for help according EWS protocol it is unclear why this case. The aim qualitative evidence synthesis was answer question ‘why HCPs fail protocols?’ findings will inform update National Clinical Effectiveness Committee (NCEC) Guideline No. 1 Irish Warning System (INEWS). Methods A systematic search published grey literature conducted (until February 2018). Data extraction quality appraisal were by two reviewers independently using standardised data forms tools. thematic studies included categorised into barriers facilitators escalation. GRADE CERQual assess certainty evidence. Results Eighteen incorporating a variety across seven countries included. escalation protocols developed five overarching themes: Governance, Rapid Response Team (RRT) Response, Professional Boundaries, Experience, parameters. Barriers included: Lack Standardisation, Resources, accountability, RRT behaviours, Fear, Hierarchy, Increased Conflict, Over confidence, Patient variability. Facilitators Accountability, Expertise, Additional support, License escalate, Bridge boundaries, empowerment, judgment, tool detecting deterioration. These all individual yet inter-related Conclusions provide insight real world experience when EWSs. This turn has potential policy-makers as well hospital management about emergency response system-related issues practice changes needed address improve patient safety care.