Human Factors and Deterioration: What Success Factors Facilitate Escalation of Care and How Can These Be Applied More Reliably?

Abstract

Timely escalation of care is critical in preventing adverse patient outcomes, yet barriers such as poor communication, role ambiguity, and hierarchical challenges persist. This article explores key human factors influencing escalation, including structured communication tools, psychological safety, and simulation-based training, emphasizing their role in reducing hesitation and improving decision-making. Organizational factors such as workload, leadership, and early warning systems (EWSs) are examined for their impact on facilitating or impeding escalation efforts. The findings highlight the effectiveness of simulation-based training in reinforcing escalation skills, particu larly in high-stakes environments, as well as the growing role of Patient and Family Activated Escalation Systems (PFAESs) in improving the early recognition of deterioration. Strategies to enhance escalation reliability include fostering interdisciplinary collaboration, inte grating structured escalation training, and optimizing patient-involvement mechanisms to strengthen safety culture. By embedding these approaches into clinical practice, healthcare systems can create a more responsive, proactive, and safer escalation framework.