A qualitative investigation into paramedics' thoughts about the introduction of national early warning scores
McClelland, Graham
Haworth, Daniel
Haworth, Daniel
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Abstract
Background The National Early Warning Score (NEWS) is a
simple, rapid assessment tool developed by the Royal College of
Physicians to standardise the assessment and monitoring of
acutely ill patients and facilitate communication across settings.
Ambulance Service introduced NEWS in 2013/14. Previous
work in this area showed that paramedics were not using NEWS
in practice so this study explored the reasons why and how
paramedics use, or don’t use, NEWS in practice.
Methods Qualitative study using a pragmatic approach.
Semi-structured interviews were conducted on a purposive volunteer sample of 8 paramedics with a range of roles, locations and lengths of service. Interviews were digitally recorded and
transcribed for analysis. Five stage framework analysis commenced in parallel with data collection.
Results Two main themes emerged from the data. The first theme
was when and how paramedics used NEWS in their decision
making. All participants thought that they, and their peers, collected all the observations necessary to calculate a NEWS but that
it didn’t enter their thoughts until after decisions had been made
and were being documented. Participants saw NEWS as a tool to
support their decisions but also thought NEWS may be beneficial
for triggering decisions by non-paramedic ambulance staff.
The second theme was how interactions with other healthcare
professionals impacted on paramedics’ use of NEWS. The reception participants received when handing a NEWS over at hospital
had a strong influence on their continuing use of NEWS. The perception that Emergency Department staff weren’t interested in
NEWS acted as a negative influence on pre-hospital practice apart
from one area where the local hospital encouraged the use of
NEWS which had a localised positive reinforcing effect.
Conclusions Paramedics use NEWS to support rather than trigger
decisions. The perceived importance placed on information handed
over at hospital influences paramedics pre-hospital practice.
https://emj.bmj.com/content/emermed/33/9/e2.3.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-2016-206139.10