Patient Safety Researchers - Low Use Escalation Cards & Receipt Proof

Five questions I do not have answers to. If you work in any of these areas, I would like to hear from you. 1. In 2013 a Danish hospital gave 1,050 patients a card entitling them to be seen by a doctor within 30 minutes if they were worried. Over two months, three people used it. Three, out of a thousand. The three calls that did come were clinically justified — two led to surgery. So it was not misuse. It was almost nobody calling. Does anyone know why? Was the mechanism unknown, unusable, or unwanted? Has anyone published an evaluation? I have found the numbers but not the explanation, and it seems to me the most important unanswered question in this area. 2. England now has a rule letting a patient or relative escalate directly if they think someone is deteriorating and is not being heard. Tens of thousands of calls have been logged. But has anyone studied who does NOT call? By language, by confidence, by whether a relative was present at all? A safety mechanism that only reaches the articulate is not reaching the people who need it most. I cannot find that analysis. Does it exist? 3. Is there any duty-to-inform, anywhere in law, that requires proof the information was RECEIVED rather than proof it was provided? Most obligations I have opened end at "made available" or "shall ensure that the person receives" — with no receipt, no acknowledgement, no comprehension check attached. Is there a jurisdiction that closed that loop? I would genuinely like to be wrong about this. 4. Does any dataset anywhere measure whether a granted right actually arrived? Not whether it was awarded. Not whether a payment cleared. Whether the person ended up with the thing, in a form they could use. The closest I have found measures payment timeliness, which is not the same. If such a dataset exists, it changes what is possible. 5. A design problem I do not know how to solve. Suppose you build a channel that pushes information to a person's designated next of kin — because the person at home cannot see in and often cannot bring themselves to ring and ask. Now suppose the designated contact is someone they are hiding from. I proposed this mechanism and someone asked who could be harmed by it. The answer stopped me. Has anyone solved the safe-contact problem in a system that must reach someone quickly and cannot verify safety first? I am asking because these are gaps, not because I have answers waiting behind them. If you have worked on any of it — including where it did not work — I would like to hear it.