Responding to the deteriorating patient: The rationale for treatment escalation plans

• Published in: The Journal of the Royal College of Physicians of Edinburgh 2022-06, Vol.52 (2), p.172-179
• Main Authors: Taylor, D Robin, Lightbody, Calvin J, Venn, Richard, Ireland, Alastair J
• Format: Article
• Language: English
• ISSN: 1478-2715; 2042-8189
• DOI: 10.1177/14782715221103390

A Treatment Escalation Plan (TEP) is a communication tool designed to improve quality of care in hospital, particularly if patients deteriorate. The aims are to reduce variation caused by discontinuity of care; avoid harms caused by inappropriate treatment and promote patients’ priorities and preferences. The TEP is based on the goals of treatment – ‘What are we trying to achieve?’ The goals take account of the context of acute illness, the consequences of interventions and discussion with the patient. They should reflect a shift away from ‘fix-it’ medicine to what is realistic and pragmatic. A TEP has three escalation categories: full escalation, selected appropriate treatments and palliative/supportive care. Other appropriate/inappropriate treatments are also recorded. Treatment Escalation Plans are associated with significant reductions in intensive care unit (ICU) admissions, non-beneficial interventions, harms and complaints. Treatment Escalation Plans contribute to staff well-being by reducing uncertainty. Successful implementation requires training and education in medical decision-making and communication skills.