• Lisa Thiele, Arthas Flabouris, and Campbell Thompson.
• The University of Adelaide, Faculty of Health and Medical Sciences, Adelaide Medical School, North Terrace, Adelaide 5000, South Australia, Australia; Registered Nurse, Intensive Care Unit, Royal Adelaide Hospital, Adelaide 5000, South Australia, Australia. Electronic address: Lisa.Thiele@sa.gov.au.
• Resuscitation. 2020 Nov 1; 156: 72-83.

BackgroundConsumer escalation systems that allow patients and/or their family/carers to escalate concerns about clinical deterioration have been proposed as a way of enhancing patient safety. However, evidence to guide implementation or to support system effectiveness remains unclear.AimTo critically evaluate the current evidence surrounding consumer escalation within the context of clinical deterioration to identify the strengths, weaknesses and gaps in existing knowledge, essential themes, and directions for further investigation.MethodDatabase searches were conducted within Cumulative Index of Nursing and Allied Health Literature, PubMed, and the Cochrane Library for articles directly relating to consumer escalation systems published, in English, within the previous 10 year-period. Titles and abstracts were screened and relevant full-text articles included. Content was examined to identify breadth of knowledge, essential themes, and the effectiveness of current systems.Results27 articles, containing a mixture of both quantitative and qualitative findings, were identified. Within the context of limitations in the overall depth and quality of current evidence, four key areas (relating to consumer understanding and awareness of clinical deterioration, confidence and ability to escalate concerns, education, and staff attitudes) were identified as potentially critical to the foundation, functioning, and success of consumer escalation systems. Consumer escalation processes may contribute positive effects beyond mortality rates; however, an agreed method of assessing effectiveness remains undetermined.ConclusionsThe ability of consumer escalation processes to achieve their underlying goals is still to be adequately assessed. Further research is required to inform how to best implement, support and optimise consumer escalation systems.Copyright © 2020 Elsevier B.V. All rights reserved.

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