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Healthcare professionals face constantly changing priorities. Consequently, when escalating a concern about a patient’s health, it is important to consider carefully the information that needs to be given and how that information can be structured into a format which conveys the intended message: that the patient needs the immediate attention of the person receiving the escalation.

It is known that ‘handover’ of information is often cognitively taxing and complex due to the amount of information and data that is known about the patient. This can lead to handovers which are unclear or miscommunicate the nursing associate’s desired outcome for the patient (Hill & Nyce 2010).

It is therefore important that when escalating concerns, the handover is planned and prepared. The focus should be on giving the essential information required to prompt the desired response and omit unnecessary information which may distract or overload the decision‐making of the recipient.

In a situation where taking a few moments to plan the escalation is not possible, it is likely that the patient requires a more immediate response where a structured communication tool is not immediately required to get help. Within an acute hospital in the United Kingdom, this will be by summoning the medical emergency team (MET) or a cardiac arrest team by calling 2222. In the patient’s own homes, general practitioner (GP) surgeries and non‐acute or community hospitals, calling 999 for an ambulance is normally required.

There are two main structures which are recommended for escalating patient care (see Table 7.1). These are the SBAR or RSVP tools.

SBAR:	RSVP:
Situation	Reason
Background	Story
Assessment	Vital Signs
Recommendation	Plan

Source: Resuscitation Council UK (2015).

The understanding of each term and examples of how to use each are found later in the chapter.

Planning your escalation and using one of the escalation tools are essential for ensuring an effective handover of patient information and concerns; reviewing all the information known about the patient by looking at the medical and nursing notes will enable you to plan each section of the escalation tool. It is likely that the reason escalation is required is because an assessment of the patient has already been completed; if not, utilising an Airway, Breathing, Circulation, Disability, Exposure (ABCDE) assessment will enable a systematic assessment of the patient and obtains the most up‐to‐date information about the patient’s vital signs and clinical presentation.