Background: Patient and/or family activated escalation may improve care to deteriorating patients. However, limited literature describes patients' and families' experience of deterioration and what barriers might restrict call activation.

Objective: This study explored patients' and families' experiences of acute ward deterioration, their perception of a need for a patient and/or family activated escalation service and barriers that may prevent them from using it.

Design: Using a qualitative cross sectional research design and a co-design approach, data were collected using face-to-face semi-structured interviews, field notes and reflective journaling. Between December 2015 and February 2016, purposeful sampling recruited 41 adult ward patients and family who either experienced a recent Medical Emergency team (MET) or Patient at Risk team (PART) escalation, or no recent MET or PART escalation.

Findings: Themes included: (1) patient awareness of their illness and deterioration, 2) the importance of returning to their normal lives, (3) reassurance on arrival of the PART and MET, (4) beliefs held to prevent use of such a service, and (5) support for a patient and/or family activated escalation service.

Conclusion: Most participants supported a patient and/or family activated escalation service, however barriers may prevent some patients from using it.

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