Recurring concern
Unreliable escalation of abnormal clinical observations
- Reports that mention this concern
- 39
- Times this concern has been raised
- 44
- Stated actions linked to this concern
- 59
What this concern includes
Includes failures in the dedicated process for recognising, interpreting, thresholding, communicating, reviewing or escalating abnormal clinical observations, including physiological, neurological and early-warning observations, where the deficiency can delay appropriate care.
What is not included
- Excludes general clinical deterioration failures where no abnormal-observation trigger or observation-based escalation process is identified.
- Excludes failures to perform or record observations when no associated failure to recognise, review or escalate abnormal findings is asserted.
- Excludes failures limited to communicating an already recognised observation to a specific recipient when the broader observation-escalation process is not deficient.
- Excludes condition-specific assessment or treatment pathways where abnormal observations are only incidental and the named condition supplies the more specific supported boundary.
Trends
Reports over time
Reports mentioning this concern, over time
Reports about this concern issued each year.
* 2026 is projected from reports observed to 7 Sep 2026.
Most frequent recipients
Most frequent recipients
Reports about this concern sent to each recipient.
Reports and published responses 39 reports
See individual reports that have raised this concern, and the actions taken in response
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Concerns raised1
Delay and inappropriate escalation of a high NEWS score
This report raised 18 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked responses
- NHS England
- the Princess Alexandra Hospital NHS Trust
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
-
the Princess Alexandra Hospital NHS Trust
Include the emergency department escalation process in area-specific orientation for nurses redeployed from their base wards.
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the Princess Alexandra Hospital NHS Trust
Provide restorative clinical supervision and professional nurse advocate learning on controlled drugs, communication, challenge and escalation.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2
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NHS England
The hospital trust is responsible for providing the response and addressing the reported concerns through its governance arrangements and actions.
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the Princess Alexandra Hospital NHS Trust
An emergency call was not required because appropriate care was initiated promptly after the raised NEWS score.
-
Concerns raised1
Lack of formal thresholds or protocols for urgent escalation of abnormal observations
This report raised 4 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
- Milton Keynes Urgent Care Services (MKUCS
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
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Milton Keynes Urgent Care Services (MKUCS
Operate standardised NEWS2 and POPS assessment within 15 minutes, with senior triage review and immediate escalation to the Emergency Department when indicated.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
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Milton Keynes Urgent Care Services (MKUCS
Standardised NEWS2/POPS assessment, senior triage review and established escalation pathways are considered sufficient to address abnormal observations.
-
Concerns raised1
Lack of an electronic observation system for automatically escalating high NEWS scores in A&E
This report raised 8 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
- Barts Health NHS Trust
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
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Barts Health NHS Trust
Implement electronic observations and Early Warning Score visibility across Emergency Department clinical areas using the upgraded patient record and observation machines.
-
Concerns raised1
Failure to escalate Early Warning Signs
This report raised 7 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
- Care Quality Commission
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
-
Care Quality Commission
Undertake an unannounced assessment covering visit duration, nutrition and hydration, health monitoring, escalation, record keeping, governance, safeguarding and decision-making.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
-
Care Quality Commission
Neither inspection raised concerns about staff failing to escalate health concerns, and the earlier inspection found appropriate healthcare referrals.
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Concerns raised1
Failure to escalate National Early Warning Scores for review
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
- East London NHS Foundation Trust
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.6
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East London NHS Foundation Trust
Require all inpatient nursing staff to complete a mandatory two-day physical health and NEWS2 training course.
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East London NHS Foundation Trust
Include NEWS2 escalation training in the annual mandatory online programme and monitor completion.
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East London NHS Foundation Trust
Standardise the nursing handover process across Tower Hamlets to communicate patient risks and physical-health observation requirements.
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East London NHS Foundation Trust
Roll out the standardised nursing handover process across the Trust’s other directorates.
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East London NHS Foundation Trust
Generate a daily NEWS2 report identifying scores of three or above, review ward responses and escalation, and record the process for audit.
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East London NHS Foundation Trust
Introduce a Nurse in Charge training tool requiring confirmation that NEWS2 monitoring and escalation responsibilities have been understood.
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Concerns raised1
Incorrect calculation of NEWS scores
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
- Aneurin Bevan University LHB
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.5
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Aneurin Bevan University LHB
Meet with the digital team to define the requirement and prioritise introducing electronic observations in the Emergency Department.
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Aneurin Bevan University LHB
Map Emergency Department processes and requirements to support electronic observation implementation.
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Aneurin Bevan University LHB
Develop an options appraisal identifying the safest, quickest and most cost-effective approach to electronic observations, including licensing and integration costs.
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Aneurin Bevan University LHB
Obtain supplier quotations and prepare a capital bid while seeking funding prioritisation for the electronic observation project.
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Aneurin Bevan University LHB
Introduce an electronic observation and NEWS recording system in the Emergency Department.
-
Concerns raised1
Failure to explicitly emphasise prompt escalation when observations cannot be obtained
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Linked responses
- Royal College of Emergency Medicine
- Royal College of Paediatrics and Child Health
- Royal Free London NHS Foundation Trust
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.5
-
Royal Free London NHS Foundation Trust
Ratify and disseminate guidance requiring unobtainable observations to be considered and escalated like abnormal observations.
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Royal College of Emergency Medicine
Continue developing a paediatric early warning score for children attending emergency departments.
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Royal College of Emergency Medicine
Support early escalation of care when vital signs cannot be obtained.
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Royal College of Paediatrics and Child Health
Introduce, embed and standardise Paediatric Early Warning Systems across the four nations.
-
Royal College of Paediatrics and Child Health
Collaborate with NHS England and the Royal College of Nursing to develop a single national Paediatric Early Warning System for England.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
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Royal College of Paediatrics and Child Health
Unobtainable observations should not automatically be treated like worrying observations because there are multiple reasons and assessment is holistic.
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Concerns raised1
Failure to establish and disseminate clear clinical standards for early warning signs
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
- Birmingham and Solihull Mental Health NHS Foundation Trust
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
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Birmingham and Solihull Mental Health NHS Foundation Trust
Incorporate further Early Warning Signs support into DIALOG+ care-planning and safety-planning training for staff.
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Birmingham and Solihull Mental Health NHS Foundation Trust
Include information and descriptor sentences defining the expected Early Warning Sign standard in CPA Part B and DIALOG+ safety plans.
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Concerns raised1
Failure to recognise the seriousness of a low or unrecordable blood pressure and continue observations
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked responses
- Department of Health and Social Care
- University Hospitals Birmingham NHS Foundation Trust
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
-
University Hospitals Birmingham NHS Foundation Trust
Deliver manual blood-pressure training and competency assessment for Emergency Department staff, including escalation and alternative perfusion assessment methods.
-
Department of Health and Social Care
Continue working with NHS England to identify resources needed for healthcare professionals to recognise and respond appropriately to patient deterioration.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
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Department of Health and Social Care
The Trust is responsible for responding directly to concerns about assessing the patient’s low blood pressure.
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Concerns raised1
Lack of warning or training for clinical staff on interpreting respiratory effort
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
No linked response statementsNo respondent-stated action or position is linked to these concerns in the published data.
Actions and positions describe what organisations say in published responses. Implementation is not independently verified.
Data last updated 7 September 2026