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    Complexity of the decision-making process of ambulance staff for assessment and referral of older people who have fallen: a qualitative study

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    Author
    Halter, Mary
    Vernon, Susan
    Snooks, Helen
    Porter, Alison
    Close, Jacqueline
    Moore, Fionna
    Porsz, Simon
    Keyword
    Emergency Medical Services
    Hospitalisation
    Falls
    Frailty
    Clinical Decision-Making
    Journal title
    Emergency Medicine Journal
    
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    URI
    http://hdl.handle.net/20.500.12417/717
    DOI
    10.1136/emj.2009.079566
    Abstract
    BACKGROUND: Older people who fall commonly present to the emergency ambulance service, and approximately 40% are not conveyed to the emergency department (ED), despite an historic lack of formal training for such decisions. This study aimed to understand the decision-making processes of emergency ambulance staff with older people who have fallen. METHODS: During 2005 ambulance staff in London tested a clinical assessment tool for use with the older person who had fallen. Documented use of the tool was low. Following the trial, 12 staff participated in semistructured interviews. Interviews were recorded and transcribed. Thematic analysis was carried out. RESULTS: The interviews revealed a similar assessment and decision-making process among participants: Prearrival: forming an early opinion from information from the emergency call. Initial contact: assessing the need for any immediate action and establishing a rapport. Continuing assessment: gathering and assimilating medical and social information. Making a conveyance decision: negotiation, referral and professional defence, using professional experience and instinct. CONCLUSIONS: An assessment process was described that highlights the complexity of making decisions about whether or not to convey older people who fall and present to the emergency ambulance service, and a predominance of informal decision-making processes. The need for support for ambulance staff in this area was highlighted, generating a significant challenge to those with education roles in the ambulance service. Further research is needed to look at how new care pathways, which offer an alternative to the ED may influence decision making around non-conveyance. https://emj.bmj.com/content/emermed/28/1/44.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/emj.2009.079566
    ae974a485f413a2113503eed53cd6c53
    10.1136/emj.2009.079566
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    Publications - London Ambulance Service

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