<![CDATA[Background: The Early Warning System (EWS) is an early detection system designed to identify deterioration in patients’ clinical conditions through the monitoring of physiological parameters. However, the effectiveness of EWS depends not only on its ability to detect clinical deterioration but also on the appropriate implementation of subsequent follow-up actions, including escalation of care. Evidence regarding the factors influencing the implementation of EWS follow-up actions remains fragmented and has not been comprehensively synthesized. Purpose: To identify, map, and synthesize scientific evidence regarding the factors influencing the implementation of EWS follow-up actions in hospital settings. Method: This scoping review was conducted based on the Arksey and O’Malley framework, as refined by Levac et al., and reported in accordance with the PRISMA-ScR guidelines. A literature search was conducted in Scopus, PubMed, and EBSCOhost for English-language articles published between 2015 and 2026. Study selection was guided by the Population–Concept–Context (PCC) framework. Data were extracted using a standardized data extraction form and analyzed narratively through thematic analysis. Results: Eleven studies were included from 6,126 records identified through the literature search. Factors influencing the implementation of EWS follow-up actions were categorized into individual, team, organizational, and system-level factors. Key facilitating factors included healthcare professionals’ clinical competence and experience, clinical judgment, self-confidence, effective multidisciplinary communication and collaboration, continuous training, clear escalation protocols, and integration of EWS with electronic medical records. The most frequently reported barriers included high workload, inadequate staffing, hierarchical cultures in clinical decision-making, ineffective interprofessional communication, poor adherence to escalation protocols, inaccurate documentation, and challenges in implementing EWS across different hospital care settings. Conclusion: The implementation of follow-up actions based on EWS is influenced by complex interactions among individual, team, organizational, and system-level factors. Optimizing EWS implementation requires a multicomponent approach that strengthens healthcare professionals’ competence, promotes a patient safety culture, improves interprofessional communication, supports effective clinical leadership, ensures adequate resources, and leverages integrated digital technologies to facilitate timely escalation of care and enhance patient safety. Keywords: Clinical Deterioration; Early Warning System; Escalation of Care; Implementation; Patient Safety.]]>
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