Decision making for patients categorised as ‘amber’ in a rural setting

Abstract

Background:Reducing unnecessary conveyances to hospital can help relieve pressure on emergency departments. Making decisions about conveyance in rural areas is particularly challenging because of the travel distances involved.Aims:To explore perceptions of paramedics in a rural setting about how they make decisions regarding conveyance and non-conveyance for patients categorised as ‘amber’ (serious but not life-threatening).Methods:Data were collected through interviews with 17 paramedics working in rural areas, which were analysed using inductive thematic analysis.Findings:Paramedics perceive hospitals as places of safety for themselves (psychological safety) and for patients (patient safety). Lower levels of psychological safety (e.g. because of an organisational blame culture) and perceived increased risks to patient safety (e.g. because of a lack of health resources in the community) influence paramedic decision making on conveying patients to hospital.Conclusion:Current practice contributes to increasing pressures on emergency departments. Ambulance services should work towards a non-punitive culture of safety where paramedics feel they can make decisions based on their experience and expertise rather than to protect themselves.

Staff perceptions of patient safety in the NHS ambulance services: an exploratory qualitative study

“…The available evidence in the literature has identified the widespread existence of a poor reporting culture across the ambulance and emergency services, where front-line staff are less inclined to report errors and mistakes due to an expectation of retribution or punishment, ultimately resulting in a high rate of unreported PSIs ( Bigham et al, 2011 , 2012 ; Chesters et al, 2016 ; Fairbanks et al, 2008 ; Fisher et al, 2015 ; Ingram et al, 2019 ; Kirk et al, 2018 ; Morello et al, 2012 ; O’Hara et al, 2014 , 2015 ; Sinclair et al, 2018 ; Verbakel et al, 2015 ). Within the United Kingdom, Kirk et al (2018) recently found that there is a lack of evidence which indicates that the NHS ambulance services have transitioned away from a culture of blame to one that is more open where staff feel comfortable to raise concerns or issues.…”