A qualitative study of systemic influences on paramedic decision making: care transitions and patient safety

In this study we aimed to look at influences on decisions made about patients by front-line ambulance service staff (paramedics). We were particularly interested in whether and where patients were transported and the impact of decisions on patient safety. We were also interested in safety culture within
the organisation and how this might influence staff.
We used a number of research methods including interviews, observations, digital diaries and focus groups with staff and service users to collect data at three ambulance service trust sites. This allowed us to gather information that represented a wide range of views and experiences. We fed back the study findings to ambulance service staff and service user participants at three workshops.
Data were analysed to identify the main issues of importance in relation to influences on staff decision-making. A number of different types of decisions that paramedics make on scene were identified along with a number of influences on decision-making. The main influences were demand, access to care services, performance targets, fear of risk, training and education, communication and resources (staff and equipment). The workshop attendees felt that these findings reflected their experiences and concerns.
Recommendations for future research include exploring effective ways of providing access to care for people who do not need to attend the accident and emergency department, assessing the effects of different staff skill levels on patient safety, exploring safe ways of improving initial telephone assessments
and exploring public awareness and expectations of the ambulance service.