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
Unclear requirements for action according to the early warning score
This report raised 11 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.4
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Action
Deliver NEWS2 training to all frontline clinical staff required to undertake the assessment.
Stated by Nottinghamshire Healthcare NHS Foundation Trust -
Action
Provide NEWS2 at-a-glance ward posters and lanyard guidance attachments.
Stated by Nottinghamshire Healthcare NHS Foundation Trust -
Action
Provide clinical supervision through senior Quality Matrons to support NEWS2 practice and continuous learning.
Stated by Nottinghamshire Healthcare NHS Foundation Trust
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Action
Introduce scenario-based NEWS2 examples during clinical supervision to assess staff competency around escalation.
Stated by Nottinghamshire Healthcare NHS Foundation Trust
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Concerns raised1
Failure to escalate, assess and investigate NEWS-triggered deterioration
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.5
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Action
Maintain and improve escalation protocols for recognising and responding to deteriorating patients.
Stated by Mid Yorkshire Teaching NHS Trust -
Action
Provide ongoing deterioration-response education to nursing, allied health and junior medical staff.
Stated by Mid Yorkshire Teaching NHS Trust -
Action
Provide a 24/7 Deteriorating Adult Response Team for patients meeting deterioration referral criteria.
Stated by Mid Yorkshire Teaching NHS Trust
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Action
Augment the deteriorating-patient response service with additional capacity.
Stated by Mid Yorkshire Teaching NHS Trust -
Action
Operate the Call 4 Concern patient-safety initiative, connecting ward calls from patients or families to Deteriorating Adult Response Team members.
Stated by Mid Yorkshire Teaching NHS Trust
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
Points 1 and 4 of the concerns are not directly relevant to the RCR’s remit or responsibilities.
Stated by Royal College of Radiologists
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Concerns raised1
Failure to accurately perform and interpret clinical observations for escalation
This report raised 14 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
Provide NEWS refresher training to relevant colleagues and conduct regular audits of NEWS compliance.
Stated by Spire Healthcare Limited -
Action
Deliver training to RMOs on recognising deteriorating patients and signs of gastric perforation.
Stated by Spire Healthcare Limited -
Action
Provide deteriorating-patient training to agency staff through the supplier competency process.
Stated by Spire Healthcare Limited
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Action
Introduce deteriorating-patient stickers for clinical use.
Stated by Spire Healthcare Limited -
Action
Display NEWS 2 posters for staff reference.
Stated by Spire Healthcare Limited
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Concerns raised1
Failure to appropriately escalate abnormal vital signs
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.
No linked response statementsNo respondent-stated action or position is linked to these concerns in the published data.
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Concerns raised1
Failure to escalate NEWS2 scores and abnormal vital observations
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.3
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Action
Adopt and implement the Managing a Deteriorating Patient policy, including monitoring and escalation guidance and regular NEWS2 baseline collection.
Stated by Holy Cross Hospital -
Action
Repeat clinical decision-making, patient-risk, NEWS2 and sepsis training for relevant ward staff.
Stated by Holy Cross Hospital -
Action
Train staff on the Managing a Deteriorating Patient policy after implementation.
Stated by Holy Cross Hospital
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Concerns raised1
Inadequate action on clinical observations and NEWS scores
This report raised 5 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.3
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Action
Provide rolling NEWS2 training covering accurate scoring, escalation, clinical deterioration and sepsis recognition.
Stated by Pennine Care NHS Foundation Trust -
Action
Progress an agreement with the Digital Health Team to provide specialist physical-health advice to inpatient clinical teams.
Stated by Pennine Care NHS Foundation Trust -
Action
Provide Acute Illness Management training for registered and unregistered nursing staff on assessing and responding to deteriorating patients, including oxygen therapy.
Stated by Pennine Care NHS Foundation Trust
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Concerns raised1
Failure to act on NEWS observations and escalate deteriorating patients
This report raised 5 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
Expand the Critical Care Outreach service to support immediate escalation from electronic NEWS scores.
Stated by University Hospitals Sussex NHS Foundation Trust
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Concerns raised1
Failure to act on NEWS scores in accordance with the NEWS Protocol
This report raised 5 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.
No linked response statementsNo respondent-stated action or position is linked to these concerns in the published data.
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Concerns raised1
Failure to escalate treatment when early warning scores require it
This report raised 6 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.
No linked response statementsNo respondent-stated action or position is linked to these concerns in the published data.
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Concerns raised1
Failure to adhere to the Early Warning System for identifying and escalating deteriorating patients
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.
No linked response statementsNo respondent-stated action or position is linked to these concerns in the published data.
Data last updated 7 September 2026