• Multiple triangulation and collaborative research using qualitative methods to explore decision making in pre-hospital emergency care

      Johnson, Maxine; O'Hara, Rachel; Hirst, Enid; Weyman, Andrew; Turner, Janette; Mason, Suzanne; Quinn, Tom; Shewan, Jane; Siriwardena, Aloysius (2017-01)
    • Perceived areas for future intervention and research addressing conveyance decisions and potential threats to patient safety: stakeholder workshops

      O'Hara, Rachel; Johnson, Maxine; Hirst, Enid; Weyman, Andrew; Shaw, Deborah; Mortimer, Peter; Newman, Chris; Storey, Matthew; Turner, Janette; Mason, Suzanne; et al. (2016-09)
      Background As part of a study examining systemic influences on conveyance decisions by paramedics and potential threats to patient safety, stakeholder workshops were conducted with three Ambulance Service Trusts in England. The study identified seven overarching systemic influences: demand; priorities; access to care; risk tolerance; training, communication and resources. The aim of the workshops was to elicit feedback on the findings and identify perceived areas for future intervention and research. Attendees were also asked to rank the seven threats to patient safety in terms of their perceived importance for future attention. Methods A total of 45 individuals attended across all the workshops, 28 ambulance service staff and 17 service user representatives. Discussions were audio-recorded, transcribed and thematically analysed. A paper based paired comparison approach was used to produce an ordinal ranking to illustrate the relative prioritisation of issues. Analysis included testing for internal consistency and between-rater agreement for this relatively small sample. Findings The two highest ranking priorities were training and development, as well as access to care. The areas for intervention identified represent what attendees perceived as feasible to undertake and relate to: care options; cross boundary working; managing demand; staff development; information and feedback; and commissioning decisions. Perceived areas for research specifically address conveyance decisions and potential threats to patient safety. 17 areas for research were proposed that directly relate to six of the systemic threats to patient safety. Conclusions Feedback workshops were effective in the validation of findings as well as providing an opportunity to identify priorities for future interventions and research. They also facilitated discussion between a variety of Ambulance Service staff and service user representatives. Ongoing collaboration between members of the research team has enabled some of the research recommendations to be explored as part of a mutually agreed research agenda. https://emj.bmj.com/content/emermed/33/9/e7.3.full.pdf This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/emermed-2016-206139.25
    • A qualitative study of systemic influences on paramedic decision making : care transitions and patient safety

      Shaw, Deborah; Mortimer, Peter; Newman, Chris; Storey, Matthew; Shewan, Jane; O'Hara, Rachel; Johnson, Maxine; Siriwardena, Aloysius; Weyman, Andrew; Turner, Janette; et al. (2015-01)
    • Thinking on scene: using vignettes to assess the accuracy and rationale of paramedic decision making

      Miles, J.; Coster, Joanne; Jacques, Richard (2018-04)
      Aim Paramedics make important decisions on-scene as to whether a patient requires transport to hospital, referred, or discharged on scene. Research shows that nearly 20% of patients brought to ED by ambulance, could be treated elsewhere. This study aims to investigate the accuracy of conveyance decisions made by on-scene paramedics. Method Individual real-patient vignettes were created using linked ambulance, ED and GP data and used in an online survey to paramedics in Yorkshire. Half the vignettes were categorised as clinically necessary attendances at the ED and the other half were categorised as clinically unnecessary. Vignettes were validated by a small expert panel. Participants were asked to determine the appropriate conveyance decision and to explain the rationale behind their decisions using a free text box. Abstracts BMJ Open 2018;8(Suppl 1):A1–A34 A23 Trust (NHS). Protected by copyright. on 13 August 2019 at Manchester University NHS Foundation http://bmjopen.bmj.com/ BMJ Open: first published as 10.1136/bmjopen-2018-EMS.62 on 16 April 2018. Downloaded from Results 143 paramedics undertook the survey and 858 vignettes were completed. There was clear agreement between paramedics for transport decisions (k=0.63) and for admission prediction (k=0.86). Overall accuracy was 0.69 (95% CI: 0.66 to 0.73). Paramedics were better at ‘ruling in’ the ED with sensitivity of 0.89 (95% CI: 0.86 to 0.92). The specificity of ‘ruling out’ the ED was 0.51 (95% CI: 0.46 to 0.56). Text comments were focused on patient safety and risk aversion. Conclusion Paramedics make accurate conveyance decisions but are more likely to over-convey than under-convey, meaning that whilst decisions are safe they are not always appropriate. Some risk-averse decisions were made due to patient and professional safety reasons. It is important that paramedics feel supported by the service to make non-conveyance decisions. Reducing over-conveyance is a potential method of reducing ED demand. https://bmjopen.bmj.com/content/8/Suppl_1/A23.3 This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/bmjopen-2018-EMS.62