Escalation and overrides
When the safety check finds a high-risk sign, nothing else can proceed until you document what you did. How that works, and how an override is recorded.
When the safety check gives Urgent referral or Emergency, the encounter stops at a red Mandatory escalation required panel. It shows:
- the reason (for example "Possible acute medical event") and each warning sign that fired,
- the recommended action — for an emergency, immediate medical assessment or emergency referral; for an urgent referral, an urgent medical evaluation.
Until you document the escalation, possible conditions, your decision and signing are all unavailable. This is enforced by the system itself, not just hidden on screen: a blocked step answers that an escalation is required.
Document what you did
Tick everything that applies under What did you do?
- Emergency services contacted
- Patient referred to hospital
- Patient declined referral
- Relative contacted
- Other (add a short note)
These are records of what you did — the system doesn't call anyone or send a referral for you. Recording that the patient declined a referral counts as a genuine escalation: you recommended it, and the refusal is on the record.
Then tick I have reviewed the escalation recommendation and select Document escalation. The encounter moves on.
If you are not going to escalate
Sometimes a clinician judges the warning wrong — for example a known, stable condition that always produces the same reading. You can continue, but not silently.
If you choose no action (or only "Other"), two more boxes appear and both are required:
- Reason for not escalating
- Clinical justification
This is an override. It is recorded permanently with your name and the time, shown on the encounter for everyone who opens it, and can be reported on by managers. It is not a way to dismiss a warning quietly; it is a way to make a deliberate, accountable decision.
What is recorded
For every escalation the encounter keeps: the category and reasons, the recommended action, what you did, who acknowledged it and when — and, for an override, the reason, the justification, who and when. The audit log records that an escalation was documented and whether it was an override, but never the clinical text you typed.
Who can do this
Anyone with Edit on the Diagnosis permission line can document an escalation. There is no separate "override" permission: the protection is the required reason and justification, not a role.