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Here’s a concise summary with bullet points and key quotes from the article "Factors influencing escalation of care of deteriorating children" by Aber Eaqub, published on Don't Forget the Bubbles:
🔍 Study Overview
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Type: Qualitative study
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Setting: Bambino Gesù Children’s Hospital, Rome – a busy tertiary paediatric hospital
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Timeframe: April–October 2015
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Participants: 32 total – 4 focus groups of HCPs (ward nurses, nurse managers, ward physicians, PICU physicians), 2 focus groups of parents
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Methodology: Focus group discussions based on standardised clinical scenarios
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Analysis: Thematic analysis using NVivo V.8
🎯 Study Objectives
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Explore HCPs’ and parents’ experiences of recognising and escalating care in deteriorating children
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Identify barriers to timely escalation
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Provide recommendations to improve patient safety and care outcomes
⚠️ Key Barriers Identified (Themes & Subthemes)
1. Staff Knowledge & Experience
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Inadequate paediatric training
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Overconfidence or underconfidence due to personal bias
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Junior staff mistrusted or overlooked
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Risk-taking behaviours
“Staff’s preconceived opinions... leading to under-or-over clinical confidence.”
2. Relationships & Leadership
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Poor teamwork and handovers
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High workload affecting communication
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Unfamiliarity with team or environment
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Hierarchical culture
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Parents feeling disempowered
“The presence of professional hierarchy”
“Disempowerment of parents”
3. Processes & Systems
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Over-reliance or disregard for monitoring tools like PEWS
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Fixated or outdated clinical judgments
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Failure to physically review patients
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Ignoring escalation protocols
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Not incorporating parents’ concerns
“Non-adherence to escalation processes”
“Not inviting parental opinions and thoughts”
4. Organisational Factors
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Staff shortages
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Uneven distribution of senior staff (day vs. night)
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Overburdened teams
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Bed shortages causing care in inappropriate locations
“Mismatch of senior staff presence during the day and night shifts”
✅ Conclusions
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Escalation challenges are systemic, not just individual failings
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Influenced by knowledge gaps, culture, communication, and resources
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Improving escalation requires multi-faceted interventions
💡 Recommendations
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Improve paediatric-specific training and mentoring
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Ensure adequate staffing, especially during night shifts
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Foster an open culture where all staff (and parents) feel empowered
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Recognise parents as valuable partners in care
“Safe care doesn’t happen by accident. It needs investment in staff... and a culture where everyone feels heard—especially at 3am.”
🧪 Critical Appraisal
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✔ Clear research objectives
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✔ Appropriate qualitative design and thematic analysis
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⚠ Limitations:
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Exclusive reliance on focus groups
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No real-time clinical observation
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Potential selection bias in participant recruitment
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Inclusion criteria excluded junior/less experienced nurses
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Emotional impact on parents—no mention of psychological support
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🏁 Bottom Line Quotes
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“Spotting deterioration matters. Early recognition, timely escalation, and the right response save lives.”
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“It’s not just about knowledge. Communication, teamwork, professional respect, and breaking down hierarchies all play a crucial role in keeping children safe.”
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“Parents are part of the team. Listen to them, value their instincts, and involve them in decision-making.”
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“Culture starts at the top... Safe care needs a culture where everyone feels heard—especially at 3am.”
Let me know if you'd like this reformatted into a handout, PowerPoint, or academic citation style.
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