Escalation policies

"Room 4 fall risk — reposition every 2 hours" demands an acknowledgement. If the on-call aide is asleep or off-grid, that unacknowledged message is a patient-safety gap. An escalation policy closes it: if a message asking for acknowledgement isn't acknowledged within a set time, Rounds automatically escalates to the next on-call tier — it pings the backup, then the next one, until someone confirms.

What a policy is

An escalation policy is an ordered list of steps. Each step says: "wait this many minutes, then notify this clinical role at this tier." A typical policy reads like a clinical chain of command:

• Step 1 — wait 5 minutes, then notify the On-call RN, tier 1.
• Step 2 — wait another 5 minutes, then notify the On-call RN, tier 2 (the backup).
• Step 3 — wait another 10 minutes, then notify the Charge Nurse.

Each step targets a clinical role, never a named person. That's deliberate — escalation should follow whoever is on call, resolved at the moment the step fires, not whoever happened to be on call when the message was first sent.

Creating a policy

Escalation policies are an agency-admin setting. The page lives inside Settings, in the Agency administration section.

1. 1

   Open Settings

   In the top-right navigation bar — visible from the chat workspace and most screens — click Settings.
2. 2

   Find Agency administration

   Scroll to the Agency administration panel near the bottom of the Settings page. It's badged Admin and only appears for agency admins.
3. 3

   Click Escalation policies

   Choose the Escalation policies card. The policy editor opens.
4. 4

   Build the ladder

   Click New policy, name it, then add a step for each tier you want the message to climb — set the wait before each step and pick the clinical role and tier it notifies.

Click to enlarge

Click to enlarge

A policy can be attached to a channel as its default, so every acknowledgement-required message in that channel is covered without anyone having to remember. A sender can also pick a policy per message.

What happens after you send

1. 1

   The clock starts

   You send an acknowledgement-required message in a channel with a policy. The message shows a live escalation status — "Escalation armed — step 1 in 4:31".
2. 2

   Acknowledged in time? Done.

   If anyone acknowledges before step 1's timer fires, the whole escalation is cancelled. No one is paged. The status flips to "Acknowledged — escalation cancelled".
3. 3

   Not acknowledged? It climbs.

   If the timer fires unacknowledged, Rounds notifies the on-call user for that step's role and tier with a STAT-grade alert, and arms the next step. The status reads "Escalated to On-call RN (tier 2)".
4. 4

   Ladder exhausted

   If every step fires and nobody acknowledges, the status shows "Escalation exhausted — no further coverage". The chain is complete, and every step is recorded in the audit log.

When the schedule and the channel disagree

Escalation never grants access to a message. If a step resolves to an on-call user who isn't a member of the channel, message visibility still applies — the alert only lands if they can actually see the message. Rounds records the gap rather than hiding it, so your agency can see when the on-call schedule and a channel's membership have drifted apart.