Recurring concern
Unreliable escalation of abnormal clinical observations
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Request correctionFirst reported 24 Sep 2013•Latest report 17 Nov 2025
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.
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.
- Reports
- 39
- Individual concerns
- 44
- Date range
- 2013–2025
- Stated actions
- 59
Distinct published reports
A report can raise multiple concerns
First to latest report issue date
Described in published responses
Reports over time
Reports 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.
Concerns and responses across reports
Only concerns grouped under this recurring concern are included. Select any concern, action or position to view the source wording.
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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.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response 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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Action
Include the emergency department escalation process in area-specific orientation for nurses redeployed from their base wards.
Stated by the Princess Alexandra Hospital NHS Trust -
Action
Provide restorative clinical supervision and professional nurse advocate learning on controlled drugs, communication, challenge and escalation.
Stated by the Princess Alexandra Hospital NHS Trust
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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Position
The hospital trust is responsible for providing the response and addressing the reported concerns through its governance arrangements and actions.
Stated by NHS England
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Position
An emergency call was not required because appropriate care was initiated promptly after the raised NEWS score.
Stated by the Princess Alexandra Hospital NHS Trust
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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.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response 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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Action
Operate standardised NEWS2 and POPS assessment within 15 minutes, with senior triage review and immediate escalation to the Emergency Department when indicated.
Stated by Milton Keynes Urgent Care Services (MKUCS
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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Position
Standardised NEWS2/POPS assessment, senior triage review and established escalation pathways are considered sufficient to address abnormal observations.
Stated by Milton Keynes Urgent Care Services (MKUCS
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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.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response 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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Action
Implement electronic observations and Early Warning Score visibility across Emergency Department clinical areas using the upgraded patient record and observation machines.
Stated by Barts Health NHS Trust
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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.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response 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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Action
Undertake an unannounced assessment covering visit duration, nutrition and hydration, health monitoring, escalation, record keeping, governance, safeguarding and decision-making.
Stated by Care Quality Commission
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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Position
Neither inspection raised concerns about staff failing to escalate health concerns, and the earlier inspection found appropriate healthcare referrals.
Stated by Care Quality Commission
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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.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response 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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Action
Require all inpatient nursing staff to complete a mandatory two-day physical health and NEWS2 training course.
Stated by East London NHS Foundation Trust -
Action
Include NEWS2 escalation training in the annual mandatory online programme and monitor completion.
Stated by East London NHS Foundation Trust -
Action
Standardise the nursing handover process across Tower Hamlets to communicate patient risks and physical-health observation requirements.
Stated by East London NHS Foundation Trust
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Action
Roll out the standardised nursing handover process across the Trust’s other directorates.
Stated by East London NHS Foundation Trust -
Action
Generate a daily NEWS2 report identifying scores of three or above, review ward responses and escalation, and record the process for audit.
Stated by East London NHS Foundation Trust -
Action
Introduce a Nurse in Charge training tool requiring confirmation that NEWS2 monitoring and escalation responsibilities have been understood.
Stated by East London NHS Foundation Trust
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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.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response 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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Action
Meet with the digital team to define the requirement and prioritise introducing electronic observations in the Emergency Department.
Stated by Aneurin Bevan University LHB -
Action
Map Emergency Department processes and requirements to support electronic observation implementation.
Stated by Aneurin Bevan University LHB -
Action
Develop an options appraisal identifying the safest, quickest and most cost-effective approach to electronic observations, including licensing and integration costs.
Stated by Aneurin Bevan University LHB
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Action
Obtain supplier quotations and prepare a capital bid while seeking funding prioritisation for the electronic observation project.
Stated by Aneurin Bevan University LHB -
Action
Introduce an electronic observation and NEWS recording system in the Emergency Department.
Stated by Aneurin Bevan University LHB
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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.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response 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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Action
Ratify and disseminate guidance requiring unobtainable observations to be considered and escalated like abnormal observations.
Stated by Royal Free London NHS Foundation Trust -
Action
Continue developing a paediatric early warning score for children attending emergency departments.
Stated by Royal College of Emergency Medicine -
Action
Support early escalation of care when vital signs cannot be obtained.
Stated by Royal College of Emergency Medicine
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Action
Introduce, embed and standardise Paediatric Early Warning Systems across the four nations.
Stated by Royal College of Paediatrics and Child Health -
Action
Collaborate with NHS England and the Royal College of Nursing to develop a single national Paediatric Early Warning System for England.
Stated by Royal College of Paediatrics and Child Health
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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Position
Unobtainable observations should not automatically be treated like worrying observations because there are multiple reasons and assessment is holistic.
Stated by Royal College of Paediatrics and Child Health
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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.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response 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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Action
Incorporate further Early Warning Signs support into DIALOG+ care-planning and safety-planning training for staff.
Stated by Birmingham and Solihull Mental Health NHS Foundation Trust -
Action
Include information and descriptor sentences defining the expected Early Warning Sign standard in CPA Part B and DIALOG+ safety plans.
Stated by Birmingham and Solihull Mental Health NHS Foundation Trust
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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.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response 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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Action
Deliver manual blood-pressure training and competency assessment for Emergency Department staff, including escalation and alternative perfusion assessment methods.
Stated by University Hospitals Birmingham NHS Foundation Trust -
Action
Continue working with NHS England to identify resources needed for healthcare professionals to recognise and respond appropriately to patient deterioration.
Stated by Department of Health and Social Care
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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Position
The Trust is responsible for responding directly to concerns about assessing the patient’s low blood pressure.
Stated by Department of Health and Social Care
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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.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
No linked response statementsNo respondent-stated action or position is linked to these concerns in the published data.
Data last updated 7 September 2026