Abstract

Introduction
Response times have been used as a key quality indicator for measuring the quality of emergency ambulance services in the United Kingdom, but criticised for their narrow focus. As outcomes become the focus of primary care commissioning of ambulance services, wider measures of quality need to be considered. The patient perspective is becoming an increasingly important dimension in primary and pre-hospital outcomes research. To that end, we aimed to investigate patients’ experiences of the 999 ambulance service to understand the processes and outcomes important to them.
Methods
We employed a qualitative design, using semi-structured interviews with a purposive sample of people who had recently used a 999 ambulance in the East Midlands. We recruited patients of different age, sex, geographical location, and ambulance service response including ‘hear and treat’ patients that received telephone advice only, ‘see and treat’ patients that were treated by clinicians on-scene and ‘see and convey’ patients that were transported to hospital. A topic guide included questions concerned with what worked well or needed to be improved, before identifying what was important to users. Framework analysis was used to facilitate the generation of practical outcomes. The interview schedule informed the initial coding frame. After subsequent interviews, the coding frame evolved to produce themes that were agreed by all members of the research team
Results
We interviewed 20 service users. Eleven men and nine women participated and 12 were aged 65 years and over. Four main themes emerged these were: arrival time; receiving correct information and advice; reassurance; and clinician behaviour and conduct.
We found that users valued a quick response when they perceived the call to be an emergency. This was of less value to those who did not perceive their situation as an emergency and irrelevant to ‘hear and treat’ users. All users valued the professional approach and information and advice given by call handlers, crew and first responders, which provided them with reassurance in a worrying situation. ‘See and convey’ users valued a seamless handover to secondary care.
Conclusion
Aspects other than response times were important to patients, particularly in situations that patients perceived to be non-emergency. We found it challenging to engage participants to consider quality indicators beyond response times because they considered these to be abstract in comparison with their concrete experiences. The results will be combined with issues identified from systematic reviews and used in a Delphi study to identify candidates for new outcome measures for emergency ambulance services which will help inform future commissioning of ambulance and out-of-hours services.