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

O'Hara, R, Johnson, M, Siriwardena, AN, Weyman, A, Turner, J, Shaw, D, Mortimer, P, Newman, C, Hirst, E, Storey, M, Mason, S, Quinn, T and Shewan, J (2014) A qualitative study of systemic influences on paramedic decision making: care transitions and patient safety. Journal of Health Services Research and Policy, 20 (1). pp. 45-53.

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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).

Item Type: Article
Divisions : Faculty of Health and Medical Sciences > School of Biosciences and Medicine > Department of Biochemical Sciences
Authors :
AuthorsEmailORCID
O'Hara, RUNSPECIFIEDUNSPECIFIED
Johnson, MUNSPECIFIEDUNSPECIFIED
Siriwardena, ANUNSPECIFIEDUNSPECIFIED
Weyman, AUNSPECIFIEDUNSPECIFIED
Turner, JUNSPECIFIEDUNSPECIFIED
Shaw, DUNSPECIFIEDUNSPECIFIED
Mortimer, PUNSPECIFIEDUNSPECIFIED
Newman, CUNSPECIFIEDUNSPECIFIED
Hirst, EUNSPECIFIEDUNSPECIFIED
Storey, MUNSPECIFIEDUNSPECIFIED
Mason, SUNSPECIFIEDUNSPECIFIED
Quinn, TUNSPECIFIEDUNSPECIFIED
Shewan, JUNSPECIFIEDUNSPECIFIED
Date : 4 December 2014
Identification Number : 10.1177/1355819614558472
Additional Information : Published in Journal of Health Services Research and Policy, 20 (1) 2014. Copyright 2014 Sage Publications.
Depositing User : Symplectic Elements
Date Deposited : 10 Dec 2014 18:12
Last Modified : 11 Dec 2014 02:33
URI: http://epubs.surrey.ac.uk/id/eprint/806889

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