Patients and caregivers plan an important role in identifying early signs of clinical deterioration. This qualitative study examines the implementation of the Rescue for Emergency Surgery Patients Observed to uNdergo acute Deterioration (RESPOND) program, a patient-led escalation system in emergency surgical care in the United Kingdom. Participants identified important enablers of successful implementation, such as leadership support, as well as barriers, such as resistance to changing professional practice and disrupting norms.