Thinking on scene: using vignettes to assess the accuracy and rationale of paramedic decision making
Miles, Jamie
; Coster, Joanne ; Jacques, Richard
Coster, Joanne
Jacques, Richard
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Abstract
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