A qualitative investigation into paramedics' thoughts about the introduction of the National Early Warning Score

Abstract

Abstract published with permission. Introduction – The National Early Warning Score is a simple, rapid assessment tool developed by the Royal College of Physicians to standardise the assessment and monitoring of acutely ill patients. The North East Ambulance Service NHS Foundation Trust introduced the National Early Warning Score in 2013/2014 to improve communication between the pre-hospital and hospital setting; however, there was and remains a lack of pre-hospital evidence that supports the value of the National Early Warning Score. A previous study showed that the utilisation of the National Early Warning Score by North East Ambulance Service NHS Foundation Trust paramedics was low. Objective – To investigate what North East Ambulance Service NHS Foundation Trust paramedics think about the National Early Warning Score and its use in practice. Design – Qualitative study using a pragmatic approach with recorded and transcribed semistructured interviews. Framework analysis commenced in parallel with data collection. Participants – A purposive volunteer sample of eight paramedics with a range of roles, locations, educational backgrounds and lengths of service. Results – Three major themes emerged from the data: applying the National Early Warning Score in practice, how the National Early Warning Score was used in decision making and how paramedic practice was subject to external influences. Conclusions – This study gives some insight into how paramedics use the National Early Warning Score in pre-hospital care and how they integrate it into their decision making. The findings also demonstrate the influence that external agencies, primarily the receiving acute hospitals, can have on pre-hospital practice.