A qualitative study of decision-making and safety in ambulance service transitions

R O'Hara, M Johnson, E Hirst, Andrew Weyman, D Shaw, P Mortimer, C Newman, M Storey, J Turner, S Mason, T Quinn, J Shewan, Niroshan Siriwardena

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Abstract

Objectives: Paramedics routinely make critical decisions about the most appropriate care to deliver in a complex system characterised by significant variation in patient case-mix, care pathways and linked service providers. There has been little research carried out in the ambulance service setting to identify areas of risk associated with decisions about patient care. The aim of this study was to explore system influences on decision making by paramedics around care transitions to identify potential risk factors.
Methods: An exploratory multi-method qualitative study was conducted in three Ambulance Service Trusts, focusing on decision making by paramedic and specialist paramedic staff. Researchers observed 57 staff across 34 shifts, 10 staff completed digital diaries and three focus groups were conducted with 21 staff.
Results: Nine types of decision were identified, ranging from ED conveyance and specialist emergency pathways to non-conveyance. Seven overarching system influences and risk factors potentially influencing decision making were identified: demand; performance priorities; access to care options; risk tolerance; training and development; communication and feedback; and resources.
Conclusions: Use of multiple methods provided a consistent picture of key system influences and potential risk factors. The study highlights the increased complexity of paramedic decisions and multi-level system influences that may exacerbate risk. The findings have implications at the level of individual Ambulance Service Trusts (e.g. ensuring an appropriately skilled workforce to manage diverse patient needs and reduce ED conveyance) and at the wider prehospital emergency care system level (e.g. ensuring access to appropriate patient care options as alternatives to ED).
Keywords: Paramedic, decision making, patient safety, system risk factors
Original languageEnglish
JournalHealth Services and Delivery Research
Volume2
Issue number56
DOIs
Publication statusPublished - Dec 2014

Keywords

  • Paramedic, decision making, patient safety, system risk factors

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