Feature: How can digital support emergency and unplanned care?

24 July, 2025

Emergency and unplanned care are high-stakes environments that demand rapid clinical decisions, clear accountability, and effective communication. Early recognition of patient deterioration, combined with swift escalation to the right team, is critical to preventing further harm to already vulnerable patients.

But across many NHS settings, escalation still depends on outdated, fragmented and unreliable systems that delay the response to deterioration. This creates added strain on staff in settings where time and resources are already in very limited supply.

Recognising the Problem

The Acute Assessment Unit (AAU) at West Hertfordshire Teaching Hospitals NHS Trust was suffering from these issues, despite a digital process being in place for recording patient observations. An internal audit revealed that while 37,275 NEWS2 triggers were recorded between March and September 2024, fewer than 7,000 included a documented escalation. In staff surveys, 40% of clinicians said escalation responses were often delayed, and half said they didn’t always know if action had been taken.

“It’s not about blaming nurses for not escalating, or doctors for not responding. The question is, are we giving them the tools to act effectively when it matters most?”

— Lucy Halpin, Associate Director of Nursing for the Deteriorating Patient

Closing the Escalation Loop

The challenge in AAU was not a lack of clinical knowledge, commitment, or desire to help patients, but the lack of effective systems and processes in place to support staff. While electronic observation tools were commonly used, the next steps in that process of escalation still depended on memory, manual admin tasks and being able to identify the right responder. This was all happening in a large ward with complex cases, rapid turnover and limited resources.

To address this, the Trust partnered with Alertive, a secure clinical communication platform used by a number of other NHS Trusts across the UK. The aim was to implement a structured, system-led approach to escalation that removed ambiguity, reduced variation and enabled clinical teams to respond with greater speed and clarity.

Designing a Structured Digital Escalation Process

The project set out to integrate observation data with real-time, role-based communication and develop a new digital NEWS2 escalation workflow. This was to be co-designed by Alertive and clinical representatives from across the Trust, then piloted in AAU, chosen due to its large size (60 beds), high patient turnover, and frequent escalations making it an ideal environment for rigorous testing.

The collaborative team, comprising Alertive experts, AAU leaders, Critical Care Outreach team (CCOT), Sepsis teams, Hospital-at-Night teams, and patient safety leads, successfully developed a new process that was both technically functional and practically effective in a real clinical setting.

When a patient’s NEWS2 score crossed a predefined threshold, an alert was triggered in under 60 seconds and routed automatically to the bay nurse, nurse in charge and the CCOT. If no action was recorded within a set window, the alert escalated to the next tier. Every interaction would be timestamped and visible to those involved in the patient’s care, and the system was embedded directly into the Trust’s EPR, Cerner Millennium, to fit neatly into existing clinical workflows.

Piloting a New Approach in a High-Demand Ward

“Now with Alertive, the right people get alerts straight away so the patient can get the right care at the right time.”

— Hardeep Singh, Senior Charge Nurse

The pilot ran in AAU for 35 days. During this time, the system averaged 12 high-priority and 19 medium-priority alerts per shift. All high-priority alerts received a response within the Trust’s 15 minute target, with an average time of 344 seconds. Along with this, unplanned ICU admissions from AAU fell from 10% to 2.3%.

Staff reported faster communication, fewer delays, and increased confidence that concerns would be addressed. By routing alerts based on roles rather than relying on memory or availability, the system reduced variation in response and allowed staff to stay at the bedside, spending more time with their patients.

“It has been really helpful not only for our staff, but more especially for the patients because they are being seen quicker.”

— Criscel May Pascua, Junior Sister, AAU

Escalation became a shared process, with clearer accountability across the team rather than reliance on individual actions. Teams could see who had responded, when, and what action had been taken. This supported safer care and helped reduce stress among staff.

The Trust also paid particular attention to the needs of Healthcare Support Workers, those often first to notice a change but least empowered to act. Staff said they felt more confident that their concerns would be taken seriously, with a system designed to back them up.

“We talk a lot about patient safety. But what about staff safety? What about the HCA who knows something’s wrong, but doesn’t have the tools or confidence to get help?”

— Lucy Halpin, Associate Director of Nursing for the Deteriorating Patient

Scaling the Model Across the Trust

Following the pilot, West Hertfordshire Teaching Hospitals NHS Trust is now expanding the digital escalation model across the organisation. New escalation pathways are being developed to reflect medical rotas, resident doctor schedules and consultant roles.

Alerts are also being tailored to support maternity and paediatric care, including integration with BadgerNet and nPEWS, as well as out-of-hours teams. As the system scales, the Trust is focused on ensuring that the digital escalation process remains embedded in clinical governance and is informed by ongoing feedback.

“Once we get them on it, the world of Alertive is our oyster… we’ll be able to develop so much more using the system across the organisation.”

— Kelly McGovern, Chief Nursing Officer

Looking Forward

The escalation pathway now acts as a benchmark across the region, with growing interest from ICS partners and other NHS Trusts. By moving from reactive to structured escalation, the system improves both patient safety and staff experience and provides a scalable model for other organisations. West Hertfordshire Teaching Hospitals NHS Trust sees the project not just as a technical upgrade, but a foundational change in how emergency and unplanned care is delivered.

For those considering similar projects, the team at West Hertfordshire Teaching Hospitals NHS Trust emphasises the importance of co-design, clinical engagement, and clear role definitions. The approach is replicable, low friction, and built on systems many Trusts already have in place. The key is integration, connecting patient data with live communication to enable structured, confident, and rapid action.