Recurring concern
Failure to escalate significant clinical concerns to appropriately senior clinicians
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Request correctionFirst reported 23 Aug 2013•Latest report 27 May 2026
What this concern includes
Includes failures of clinical escalation for significant patient concerns, abnormal findings, changing clinical conditions or treatment problems where escalation to an appropriately senior clinician is required, including obstetric escalation and escalation by junior staff during busy shifts.
Not included
- Excludes generic organisational governance failures where no clinical concern requiring senior clinical review is identified.
- Excludes failures of escalation in non-clinical operational, safeguarding, complaints or emergency-control-room processes.
- Excludes delays in senior review where the failure is solely lack of consultant availability and no escalation deficiency is identified.
- Excludes failures limited to documentation, communication or training unless they directly constitute or undermine escalation of a significant clinical concern.
- Reports
- 72
- Individual concerns
- 81
- Date range
- 2013–2026
- Stated actions
- 103
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
Failure to escalate concerning patient presentations to a doctor
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 escalate post-PEG patient concerns to a senior doctor for consideration of possible bleeding
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.
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Concerns raised1
Failure to alert senior clinicians to unexpected patient deterioration
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.3
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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
Introduce deteriorating-patient stickers for clinical use.
Stated by Spire Healthcare Limited
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Concerns raised1
Failure to escalate eligible emergency department patients for consultant review
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.3
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Action
Implement a policy empowering any multiprofessional team member to escalate delayed assessment or transfer to the consultant on call.
Stated by University Hospitals Birmingham NHS Foundation Trust -
Action
Deliver an education programme on escalation for delayed assessment or transfer from August 2023.
Stated by University Hospitals Birmingham NHS Foundation Trust -
Action
Deliver direct teaching and display laminated posters in acute surgical areas at all acute sites by 31 October 2023.
Stated by University Hospitals Birmingham NHS Foundation 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
Responsibility for addressing emergency department patient volume rests with the Department of Health and Social Care.
Stated by University Hospitals Birmingham NHS Foundation Trust
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Concerns raised1
Delay in calling the ITU team during critical emergencies
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 share iliac artery aneurysm information to trigger Consultant Vascular Surgeon advice
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
Communicate the requirement for accurate information in clinician referrals through clinical directors and regular team training.
Stated by East Kent Hospitals University NHS Foundation Trust
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Concerns raised1
Failure to escalate critical A&E blood-test abnormalities to the senior clinician
This report raised 9 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 of junior staff to seek senior advice about anticoagulation interactions before administration
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 contact the respiratory on-call consultant on repeat presentation
This report raised 19 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
Hold daily multidisciplinary morning report meetings to discuss cases and make appropriate specialty referrals.
Stated by Norfolk and Norwich University Hospitals NHS Foundation 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
A further respiratory referral was not considered necessary because the patient had the same symptoms only two days earlier.
Stated by Norfolk and Norwich University Hospitals NHS Foundation Trust
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Concerns raised1
Failure of systems to provide supervision and escalation of complex cases involving junior doctors
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.2
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Action
Use Care Flow to require consultant sign-off for specified patients and senior review before learning-disability patient discharge.
Stated by Barking, Havering and Redbridge University Hospitals NHS Trust -
Action
Deliver teaching on diagnostic overshadowing and senior escalation, and add safeguarding and diagnostic overshadowing to the induction pack.
Stated by Barking, Havering and Redbridge University Hospitals NHS Trust
Data last updated 7 September 2026