Make the concern and the needed action clear
Escalating a patient-safety concern means bringing an unresolved issue to someone who can help assess or address it. The appropriate route depends on urgency and the organization’s response system. A routine message or incident report should not become the default route for a situation needing immediate attention.
AHRQ’s TeamSTEPPS program offers SBAR: situation, background, assessment and recommendation or request. Its value is a focused exchange that makes the problem and requested response understandable. It is a communication framework, not a treatment protocol.
Prepare a concise message
Start with the current concern and urgency. Supply the observations and relevant background that explain why you are calling. State what you need and when you need it. If you do not know the cause, say so rather than delay until you can name a diagnosis.
A fictional communication exercise might use: “I am concerned about a change since the last assessment. These are the findings. I need an assessment now and a plan for whom to contact if the concern remains unresolved.” Replace general wording with the real observations and follow the local emergency-response process when indicated.
Avoid burying the request inside a long history. Keep supporting information available for questions, but make the first sentence useful to someone hearing the situation for the first time.
Confirm what will happen next
Before ending the exchange, confirm who will respond, the agreed action and the expected timing. Repeat important instructions using the organization’s communication practices. Identify the next contact if the expected response does not occur.
TeamSTEPPS teaches that an ignored concern should be stated again and that an unresolved safety issue should be escalated through other team members or the supervisory chain. Its Two-Challenge Rule is not a requirement to wait through two failed conversations during an emergency. The immediate response system takes priority when the situation calls for it.
Keep a visible record of follow-up
Document relevant assessments, communications, actions and responses in the appropriate record. A useful local review asks whether someone taking over care can see what remains unresolved and who is responsible for the next step. Use a safety report for process learning when appropriate, without substituting it for clinical communication.
For recurring problems, bring the pattern to the designated safety or management forum with concrete examples handled through approved privacy channels. Ask what response standard applies and how the team will know whether the escalation route works.
Practice both sides of the exchange during orientation: raising the concern and receiving it. A nurse who asks for help needs a usable response; a clinician who receives a concern needs to acknowledge it and make the next action explicit. See speaking up across hierarchies for how teams can make that exchange easier.
Sources
- AHRQ TeamSTEPPS: SBAR (accessed 2026-09-17).
- AHRQ TeamSTEPPS: Mutual Support (accessed 2026-09-17).