Treatment Escalation Plans


A Treatment Escalation Plan (TEP) is a tool which records and communicates the personalised and realistic goals of treatment. It should reflect the values and preferences that are important to the person receiving care if their condition should deteriorate.

"Making it easier to do the right thing" "No DNACPR without a TEP"

You may want to review our related resources on Palliative Care which can be found within "Trainee Resources"

Treatment Escalation Plans

Dr Joanne Mackie explains more about treatment escalation plans in this induction video. This includes a practical guide to decision making around TEPs, having the conversation and completing the TEP on TRAK.

Realistic Conversations: Part 1

This is a video developed by NHS Greater Glasgow and Clyde, where Dr Chris McNally (Acute Physician) demonstrates a treatment escalation planning discussion with a simulated patient

Realistic Conversations: Part 2

This is a video developed by NHS Greater Glasgow and Clyde, where Dr Chris McNally (Acute Physician) demonstrates a treatment escalation planning discussion with relatives over the phone

How to Use the TEP training video

TEP Having the Conversation under pressure


TEP Guidance Notes

The Guidance Notes are an essential read for anyone using the TEP for the first time. They provide information about medical decision-making leading to Goals of Treatment, medico-legal and ethical boundaries in relation to informed discussion with the patient or their POA, and a practical explanation about how to complete a TEP.

Frequently Asked Questions


Sign 167 Guideline - Care of Deteriorating Patients

This guideline provides evidence-based and consensus recommendations for best practice in the management of clinical deterioration in non-pregnant adult patients. The focus is on timely planning, recognition and escalation of those experiencing acute deterioration.

The Evidence: relevant literature on the topic of TEPs

A list of papers published in the medical literature which is relevant to the topic of Treatment Escalation Plans. Updated twice annually.

Useful TEP Resources

The REDMAP approach to conversations with unstable patients

In this video by Dr Kirsty Boyd, Reader in Palliative Care, University of Edinburgh, provides a framework for holding conversations if a patient is seriously ill and there are threats to recovery. Developed during the COVID emergency, the video still provides useful training in communication.

Meaningful Conversations

Helpful resources on conversations from Healthcare Improvement Scotland ihub including a set of helpful ACP conversation prompt cards

NES Resources

NHS Education for Scotland have developed really useful resources on having realistic conversations, treatment escalation planning and using REDMAP here

What to do at 3am? Comprehensive education module

This series of videos was developed by Dr. Jack Fairweather under the auspices of the Royal College of Physicians and Surgeons of Glasgow. This is quite a substantial module, but it is covers lots of relevant issues and is well worth while.

You will need to register free of charge at:

The Royal College of Physicians and Surgeons of Glasgow | Difficult Discussions at 3am (

After registration you will click on “My Digital Learning” and arrive at:

There are two modules available:

  1. Ethics and the Law, and where this fits with national policy and

  2. Practical and clinical approaches

There is a specific section in module 2 which covers Treatment Escalation Plans (section 6)

St Mungo’s Podcast

A discussion with Professor Robin Taylor led by Dr Eoghan Colgan, an ED consultant and the producer of St. Mungo’s broadcasts. A good easy-to-digest introduction to the TEPs topic.

Talking Mortality

This is a series of podcasts led by Dr Calvin Lightbody, an ED consultant in Hairmyres Hospital. The topics covered are:

  • Addressing the death taboo*

  • Critical Illness, prognosis, hope and truthfulness*

  • Spiritual pain at the end of life*

  • Things go better with planning*

  • Dementia - a realistic conversation

  • Palliative Care - myths, mysteries and reality

  • Focus on Frailty I

  • Focus on Frailty II

  • Mairi’s story – the experience of a dementia patient’s family in an acute care hospital

* = relevant to Treatment Escalation Planning

Discussing Dying

This is a short crisp cartoon-style video produced by NES about conversation skills and content for situations where the patient may be dying.


STEPS for TEPS for Consultants, Trainee medical staff and Charge Nurses

Composed by Prof. Robin Taylor (NHS Lothian). Available for anyone to use, Set 1: Suitable for consultants and middle grade trainees. Contains a large number of slides, not intended to be for a single session! Set 2: Suitable for junior medical staff Set 3: Suitable for nurses