Escalation Quick Tool | The Ward Wise

Step 1

Immediate danger check

Do this before filling anything else in.

This is not immediate danger; I am organising a clear escalation. This may be immediate danger or rapid deterioration; urgent staff help is needed now.

Do not wait for forms: severe breathlessness, collapse, hard to wake, chest pain, stroke-like symptoms, severe bleeding, suicidal thoughts, or sudden major change needs urgent help now.

Step 2

Name the concern

Keep this to one concern if possible. One clear concern lands better than ten scattered issues.

The concern

What I am seeing / what has happened

Step 3

Name the risk

Escalate the risk, not just the frustration.

Deterioration or worsening symptoms New or worsening confusion / not normal baseline Pain, distress, hydration, eating, mobility, toileting, or safety concern Medication list, side effect, missed dose, or wrong/unclear medicine concern Discharge, care, equipment, follow-up, or home-safety concern Pending results, review, or ownership concern Safeguarding, neglect, abuse, coercion, serious vulnerability, or unsafe environment concern

The risk I am worried about is...

Step 4

Make a clear request

A concern is easier to act on when it includes a specific ask.

Review the patient now Explain the plan in plain English Document the concern Ask the nurse in charge / shift coordinator to review Ask the doctor / senior clinician to review Reconcile or review the medication list Clarify whether discharge is safe today

Escalation script: “I am concerned about [concern]. What I am seeing is [evidence]. The risk I am worried about is [risk]. Can you [specific request], and tell me who owns this and when I should expect an update?”

Step 5

Named owner and timeframe

A concern is not properly owned until someone can say who is responsible, what happens next, and when you should expect an update.

Who owns this concern now?

When should I expect an update?

Step 6

Escalation route

Use the right route for the situation. Acronyms are written out here to avoid confusion.

Bedside nurse / relevant professional Nurse in charge, ward manager, matron, doctor, registrar, or consultant team Martha’s Rule / Call for Concern route for deterioration not being heard or acted on Patient Advice and Liaison Service (PALS) for support with unresolved concerns while care is ongoing Formal complaints route for serious, unresolved, retrospective, or investigation-level concerns Care Quality Commission (CQC) feedback route for concerns about poor care or patterns in England — not urgent bedside action and not usually the route to resolve an individual complaint in the moment

Step 7

Safeguarding or serious vulnerability

If the concern involves neglect, abuse, coercion, serious vulnerability, unsafe discharge into an unsafe environment, or someone being unable to protect themselves, ask what safeguarding route applies. This is separate from ordinary dissatisfaction or routine complaint.

Safeguarding phrase: “I am concerned this may be a safeguarding issue because [specific reason]. Who is the safeguarding lead or route for this ward, and how will this be recorded and acted on?”

Step 8

Record what happened

Write down what happened so the concern does not disappear into a verbal conversation.

Who I spoke to

Response given / action promised