Back J, Ross AJ, Duncan MD, Jaye P, Henderson K, Anderson JE. (2017). Emergency Department Escalation in Theory and Practice: A Mixed-Methods Study Using a Model of Organizational Resilience. Annals of Emergency Medicine.

What keeps your emergency department (A&E) safe?

This paper, published in the Annals of Emergency Medicine, outlines how escalation policies are used by emergency departments when responding to an increase in demand (eg, a sudden inflow of patients) or a reduction in capacity (eg, a lack of beds to admit patients). The policies aim to maintain the ability to deliver patient care, without compromising safety, by modifying “normal” processes. The study objective is to examine escalation policies in theory and practice.

What is already known on this topic

Care delivery organizations commonly develop “escalation policies” for managing crowding and surges in emergency department demand. The effectiveness of these policies has seldom been studied.

What questions this study addressed

This study used mixed methods to identify common patterns in escalation policies in UK EDs and to evaluate how well they performed in practice.

What this study adds to our knowledge

Formal escalation policies often presumed the availability of resources that were missing or degraded when escalation was needed. Consequently, the actual practice of managing crowding deviated from that inscribed in policy.

How this is relevant to clinical practice

Recognizing and monitoring the gap between formal policies and actual practice should help in the development of more realistic and useful escalation policies.

Please read our open access paper here: Understanding ED escalation