ESCALATION system improves the recognition of and response to paediatric clinical deterioration

Dr Fenella Gill, 2019 Early Career Fellowship recipient

Over its first five years, WAHTN distributed more than $3.85 million from the Medical Research Future Fund (MRFF) to Early Career Fellowships and Health Service Translational Research Projects in Western Australia. In this series, we catch up with funding recipients to find out what they achieved and where it’s led them.

Dr Fenella Gill was one of 11 researchers awarded a 12-month WAHTN Early Career Fellowship in Translational Health Research

Fenella’s project, “Unifying systems for recognition and response to paediatric clinical deterioration in Western Australia”, addressed the lack of a uniform approach to recognising and responding to clinical deterioration for hospitalised children in WA – something that could contribute in failure to recognise or respond in a timely manner to critical changes in a child’s condition, potentially resulting in adverse outcomes.

The project aimed to develop an evidence based state-wide system for recognising and responding to clinical deterioration in WA paediatric settings inclusive of family participation and to evaluate the feasibility and factors necessary to ensure successful implementation.

Following an evidence review and stakeholder consultation, Fenella led co-production of a system named ESCALATION with a working group that included nurses, doctors, health consumers and a human factors principles expert.

Two years on, version 3.0 of the ESCALATION system (which had the addition of sepsis prompts and a sepsis escalation pathway) was implemented at Perth Children’s Hospital (PCH) and Broome Hospital, and the Department of Health is coordinating a state-wide rollout for v4.0. Fenella and the team refined the education and training resources and tested suitability for the state-wide rollout using clinical simulation research.

Fenella said the fellowship program was an opportunity to demonstrate her ability to lead large-scale implementation research. “I gained invaluable experience in leading a research team, working across health services and navigating multiple research ethics and governance processes. The project enabled me to strengthen collaborative relationships with key stakeholders in health services, organisations and consumer groups.”

Since completing the fellowship project in August 2020, Fenella has been continuing her research on paediatric inpatient and family experiences, safety and outcome in her role as Associate Professor at Curtin and PCH. Associate Professor Fenella Gill is also one of the Implementation Science Fellowships recipients, announced in May 2022 for her Paediatric ‘Escalation’ System. More information on this project is available at

 To stay update with her current research or achievements, you can find Dr Fenella Gill on LinkedIn and Twitter and at Curtin University.


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