RSVP
The RSVP escalation method was initially introduced by the Acute Life‐threatening Events – Recognition and Treatment (ALERT) course (Featherstone et al. 2008). Table 7.2 provides an overview of the RSVP escalation method.
With regards to the discussion in Table 7.2, this must also be documented, and the nursing associate must adhere to local policy and procedure.
Touch Point
There are some differences between the SBAR and RSVP tool. Many organisations will instruct clinical staff on which one to use within the organisation. It is important, however, to remember that whichever tool you use, its purpose is planning and delivering escalation effectively and advocating for your patient’s need for immediate help.
Who to Escalate To?
The routes of escalation will vary depending on your workplace, internal protocols and policies. Routes to escalation may change throughout the 24‐hour shift. A list of options is provided, but you must familiarise yourself with the options available in your clinical area.
Yellow Flag
Table 7.2 An overview of the RSVP escalation method.
| RSVP ELEMENT | ACTIONS | EXAMPLE |
|---|---|---|
| Reason | State your name and role and confirm who you are talking to. Give the patient’s name and location. Give the reason for the call. | My name is Janusz Nowak; I’m a nursing associate. I’m calling about a patient, Jane Doe, on Ward 1, who is experiencing chest pain currently. |
| Story | Give the background information about the patient, reason for admission, relevant past medical history and resuscitation status. | Jane is an 85‐year‐old female admitted two days ago with raised troponin test leading to a diagnosis of non‐ST elevation myocardial infarction. She is awaiting an inpatient angiogram. Her past medical history is hypertension and angina. Her resuscitation status was assessed yesterday and she is for resuscitation. |
| Vital Signs | Give abnormal vital signs as well as sign/symptoms and a description of your visual assessment of the patient. | She appears pale and her skin is clammy. She is tachypnoeic with a respiration rate of 28, tachycardic with a heart rate of 112, with a weak, palpable radial pulse. She is hypotensive with a blood pressure of 92/56. All other observations are within normal parameters. Her total NEWS score is 7. |
| Plan | Give your current plan and ask for a further plan from the recipient. Ask now for anything you want them to do. | We are going to connect to a monitor and complete serial ECGs. Please come and assess this patient immediately. |
Registered Nurse
A registered nurse is a healthcare professional who has expertise in the delivery of professional nursing care to patients. It is important to remember that registered nurses possess a number of assessment, evaluation and clinical decision‐making skills as well as specific knowledge of disease pathology, pharmacology/medicines management and non‐medical treatments and therapies within the context of compassionate and caring nursing skills.
Registered nurses also maintain accountability for patients under their care, and consequently, a registered nurse should be notified of your assessment of the patient.
The registered nurse may have the ability to manage a patient by putting into place a plan of care which may not necessarily require the patient to be escalated to a physician or other healthcare professional. Registered nurses may have significant experience in the specialism and have developed additional specialist skills and knowledge; they may have access to patient group directives or be non‐medical prescribers, allowing them to administer medications without a direct prescription and as such, and they can be consulted for advice and intervention.
Nurse Practitioners (NPs)/Advanced Clinical Practitioners (ACPs)
These are registered nurses and sometimes practitioners from other healthcare professions who have advanced training, skills and knowledge which may overlap that of medical practitioners. NPs and ACPs may be able to provide advice, intervene and provide monitoring beyond that of other registered nurses and healthcare professionals.
Foundation Year 1 (FY1) and Foundation Year 2 (FY2) Doctors
FY1 doctors are ‘newly qualified’ doctors undergoing a pre‐registration year of experience under very close supervision of a consultant or GP. FY2 doctors have completed the FY1 year and have obtained full registration as a doctor but remain under the supervision of a consultant. When working in a hospital, these are often the first point of contact for concerns about patients.
Core Trainee Or Specialist Trainee Doctors
These are doctors who have completed their foundation training and are now developing in their specialist field of medicine. These doctors are more experienced, and in the later years of training, they are often still referred to as an older term ‘Specialist Registrars’, meaning they are in the final stages of their training to become a consultant.
Consultant
A consultant is a doctor who has completed speciality training in their specialist medical field. It is rare that consultants provide immediate response to patient concerns; but many are approachable and will often be contacted by more junior doctors for advice and guidance.
Critical Care Outreach Team
Acute hospitals may have a critical care outreach team comprised normally of registered nurses (and sometimes other roles) with significant clinical experience in intensive care or the emergency department and therefore expert at assessing, monitoring and treating unwell and deteriorating patients.
Critical care outreach teams may also provide ongoing monitoring for unwell patients on wards and provide advice and support to nursing and medical staff.
Outreach teams may also carry out other technical roles too,