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A Simple Escalation Memory Aid

• Notice the concern
• Stay within role
• Ask factual questions
• Use the local route
• Record and hand over
• Check ownership

Recognise

• Escalate when a contact describes emergency features, clear clinical deterioration or urgent mental health risk.
• Incomplete or confused information can be unsafe. Escalate if the patient says they cannot wait, will not or cannot explain, or cannot communicate clearly.
• Results, medication queries, symptom interpretation and requests for clinical advice usually require clinician review.
• Lower the threshold for escalation with vulnerable, distressed, deteriorating, pregnant, recently discharged, frail or socially isolated patients.

Respond

• Use the local escalation route as soon as the concern is clear or safe routing is not possible.
• Do not diagnose or clinically triage from reception, care navigation or call-handling roles.
• Do not interpret results or give medicines advice unless an agreed local process explicitly permits it.
• Do not give clinical reassurance or tell the person it is safe to wait when urgent wording is present.
• Escalate uncertainty rather than attempting to resolve unsafe or unclear contacts yourself.

Record and Handover

• Record exact words, time, contact route, patient location and reliable call-back details.
• Record relevant context, including vulnerability, refusal, distress, missing information or communication difficulty.
• Record action taken, noting who accepted ownership and which urgent route was used.
• Document complications such as failed call-back, disconnection, refusal, online delay or remaining uncertainty.
• Keep urgent wording visible rather than reducing it to vague phrases such as "wants call", "query" or "advice".

Practice Systems

• Provide visible prompts, clear scripts, named urgent owners and reliable backup routes for staff.
• Monitor online requests, task lists, results workflows and prescription messages so urgent wording is not missed.
• Define failed-contact rules for calls that drop, patients who leave, or delays in assigning urgent ownership.
• Use near misses to improve systems, not only to remind individuals.