A qualitative study of systemic influences on paramedic decision making: care transitions and patient safety

O'Hara, Rachel and Johnson, Maxine and Siriwardena, A. Niroshan and Weyman, Andrew and Turner, Janette and Shaw, Deborah and Mortimer, Peter and Newman, Chris and Hirst, Enid and Storey, Matthew and Mason, Suzanne and Quinn, Tom and Shewan, Jane (2015) A qualitative study of systemic influences on paramedic decision making: care transitions and patient safety. Journal of Health Services Research & Policy, 20 (S1). pp. 45-53. ISSN 1355-8196

Full content URL: http://hsr.sagepub.com/content/20/1_suppl/45

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A qualitative study of systemic influences on paramedic decision making: care transitions and patient safety

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Abstract

Objectives: Paramedics routinely make critical decisions about the most appropriate care to deliver in a complex system characterized by significant variation in patient case-mix, care pathways and linked service providers. There has been little research carried out in the ambulance service to identify areas of risk associated with decisions about patient care. The aim of this study was to explore systemic influences on decision making by paramedics relating to care transitions to identify potential risk factors.
Methods: An exploratory multi-method qualitative study was conducted in three English National Health Service (NHS) Ambulance Service Trusts, focusing on decision making by paramedic and specialist paramedic staff. Researchers observed 57 staff across 34 shifts. Ten staff completed digital diaries and three focus groups were conducted with 21 staff.
Results: Nine types of decision were identified, ranging from emergency department conveyance and specialist emergency pathways to non-conveyance. Seven overarching systemic influences and risk factors potentially influencing decision making were identified: demand; performance priorities; access to care options; risk tolerance; training and development; communication and feedback and resources.
Conclusions: Use of multiple methods provided a consistent picture of key systemic influences and potential risk factors. The study highlighted the increased complexity of paramedic decisions and multi-level system influences that may exacerbate risk. The findings have implications at the level of individual NHS Ambulance Service Trusts (e.g. ensuring an appropriately skilled workforce to manage diverse patient needs and reduce emergency department conveyance) and at the wider prehospital emergency care system level (e.g. ensuring access to appropriate patient care options as alternatives to the emergency department).

Keywords:decision making, paramedic, patient safety, system risk factors, bmjgoldcheck, NotOAChecked
Subjects:B Subjects allied to Medicine > B900 Others in Subjects allied to Medicine
A Medicine and Dentistry > A300 Clinical Medicine
Divisions:College of Social Science > School of Health & Social Care
ID Code:16175
Deposited On:04 Dec 2014 08:43

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