It’s Time to Talk to Prehospital Providers: Feedback Disparities among Ground-Based Emergency Medical Services Providers and its Impact on Job Satisfaction

McGuire, S.; Luke, Anuradha; Klassen, Aaron B; Myers, Lucas A.; Mullan, Aidan F.; Sztajnkrycer, Matthew D.

doi:10.1017/s1049023x21000601

Cited by 13 publications

(19 citation statements)

References 13 publications

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“…Our survey revealed that only 6.2% of paramedics receive formal feedback on stroke, however, more than two-thirds of them think that hospital-directed feedback is crucial and would improve their future decision-making. These findings are in line with other studies, where formal feedback is noted as highly desirable for EMS staff members, yet not sufficient [ 8 , 10 , 12 , 13 , 14 , 19 , 28 , 29 , 30 ]. Previous studies have shown that hospital-directed feedback to EMS is associated with improved overall compliance with state protocols, increased hospital prenotification, and improved stroke timeliness metrics in patients with ischemic stroke [ 12 ].…”

Section: Discussionsupporting

confidence: 92%

Prehospital Stroke Care, Paramedic Training Needs, and Hospital-Directed Feedback in Lithuania

et al. 2022

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Background: Emergency medical services (EMS) are the first health care contact for the majority of stroke patients. However, there is a lack of data on the current paramedics’ hospital-directed feedback and training needs across different health care settings. We aimed to evaluate paramedics’ prehospital stroke care knowledge, training needs, and current status of feedback on suspected stroke patients. Methods: We surveyed paramedics from the Vilnius region from September to November 2019 and compared the answers between the city and the district agencies. The questionnaire content included questions on paramedics’ demographic characteristics, prehospital stroke care self-assessment, knowledge on stroke mimics, stroke training needs, and the importance of hospital-directed feedback on suspected stroke patients. Results: A total number of 161 paramedics (or 49.4% of all paramedics from our stroke care network) were surveyed, with more district paramedics rating their prehospital stroke care knowledge as inadequate (44.8% (95% confidence interval (CI) 32.8–57.6) vs. 28.1% (95% CI 20.1–27.8), p = 0.028). In addition, more district paramedics indicated a need for additional stroke training (83.1% (95% CI 71.5–90.5) vs. 69.8% (60.0–78.1), p = 0.043). However, respondents reported being the most confident while dealing with stroke (71.3%, 95% CI 63.8–77.7) compared to other time-critical conditions (p < 0.001). Vertigo (60.8%, 95% CI 53.0–68.0), brain tumors (56.3%, 95% CI 48.5–63.8), and seizures (54.4%, 95% CI 46.7–62.0) were indicated as the most common stroke mimics. Only 6.2% (95% CI 3.4–11.1) of respondents received formal feedback on the outcome of suspected stroke patients brought to the emergency department. Conclusions: A high proportion of paramedics self-perceive having inadequate stroke knowledge and an urgent need for further stroke training. The EMS staff indicate receiving insufficient feedback on suspected stroke patients, even though its usefulness is perceived as paramount.

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Section: Discussionsupporting

confidence: 92%

Prehospital Stroke Care, Paramedic Training Needs, and Hospital-Directed Feedback in Lithuania

et al. 2022

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Section: Discussionsupporting

confidence: 91%

Prehospital Stroke Care, Paramedic Training Needs, and Hospital-Directed Feedback in Lithuania

Melaika¹,

Sveikata²,

Vilionskis³

et al. 2022

Preprint

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Background: Emergency medical services (EMS) are the first health care contact for the majority of stroke patients. However, there is a lack of data on the current paramedics’ hospital-directed feedback and training needs across different health care settings. We aimed to evaluate paramedics’ prehospital stroke care knowledge, training needs, and current status of feedback on suspected stroke patients. Methods: We surveyed paramedics from the Vilnius region from September to November 2019, and compared the answers between the city and the district agencies. The questionnaire content included questions on paramedics’ demographic characteristics, prehospital stroke care self-assessment, knowledge on stroke mimics, stroke training needs, and the importance of hospital-directed feedback on suspected stroke patients. Results: A total number of 161 paramedics were surveyed, with more district paramedics rating their prehospital stroke care knowledge as inadequate (44.8% (95% confidence interval (CI) 32.8–57.6) vs 28.1% (95% CI 20.1–27.8), p = 0.028). In addition, more district paramedics indicated a need for additional stroke training (83.1% (95% CI 71.5–90.5) vs 69.8% (60.0–78.1), p = 0.043). However, respondents reported being the most confident while dealing with stroke (71.3%, 95% CI 63.8–77.7) compared to other time-critical conditions (p < 0.001). Vertigo (60.8%, 95% CI 53.0–68.0), brain tumours (56.3%, 95% CI 48.5–63.8), and seizures (54.4%, 95% CI 46.7–62.0) were indicated as the most common stroke mimics. Only 6.2% (95% CI 3.4–11.1) of respondents received formal feedback on the outcome of suspected stroke patients brought to the emergency department. Conclusion: A high proportion of paramedics self-perceive having inadequate stroke knowledge and an urgent need for further stroke training. The EMS staff indicate receiving an insufficient amount of feedback on suspected stroke patients, even though the usefulness is perceived to be paramount.

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“…The non-interventional studies all reported that EMS professionals were dissatisfied with current feedback provision and desired more feedback, particularly patient outcome feedback 10–12 31 74 75. Concerns were that feedback was skewed towards the negative10 75 and only triggered by highly traumatic incidents,11 while EMS professionals desired routine, frequent and high-quality feedback 10–12. One UK study suggested that EMS professionals desired ‘pull’-type feedback, that is, initiated by individual clinicians, delivered electronically or involving staff mediators 11.…”

Section: Resultsmentioning

confidence: 99%

“…Potential social barriers were also highlighted, including how staff interact with and respond to feedback, especially within EMS culture where feedback may be perceived as linked to disciplinary action or being of questionable value 10 12. A reported ethical barrier was sharing of confidential patient details, especially for non-hospital-affiliated EMS agencies in the USA 10 75…”

Section: Resultsmentioning

confidence: 99%

Types and effects of feedback for emergency ambulance staff: a systematic mixed studies review and meta-analysis

et al. 2023

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BackgroundExtensive research has been conducted into the effects of feedback interventions within many areas of healthcare, but prehospital emergency care has been relatively neglected. Exploratory work suggests that enhancing feedback and follow-up to emergency medical service (EMS) staff might provide staff with closure and improve clinical performance. Our aim was to summarise the literature on the types of feedback received by EMS professionals and its effects on the quality and safety of patient care, staff well-being and professional development.MethodsA systematic review and meta-analysis, including primary research studies of any method published in peer-reviewed journals. Studies were included if they contained information on systematic feedback to emergency ambulance staff regarding their performance. Databases searched from inception were MEDLINE, Embase, AMED, PsycINFO, HMIC, CINAHL and Web of Science, with searches last updated on 2 August 2022. Study quality was appraised using the Mixed Methods Appraisal Tool. Data analysis followed a convergent integrated design involving simultaneous narrative synthesis and random effects multilevel meta-analyses.ResultsThe search strategy yielded 3183 articles, with 48 studies meeting inclusion criteria after title/abstract screening and full-text review. Interventions were categorised as audit and feedback (n=31), peer-to-peer feedback (n=3), postevent debriefing (n=2), incident-prompted feedback (n=1), patient outcome feedback (n=1) or a combination thereof (n=4). Feedback was found to have a moderate positive effect on quality of care and professional development with a pooled effect of d=0.50 (95% CI 0.34, 0.67). Feedback to EMS professionals had large effects in improving documentation (d=0.73 (0.00, 1.45)) and protocol adherence (d=0.68 (0.12, 1.24)), as well as small effects in enhancing cardiac arrest performance (d=0.46 (0.06, 0.86)), clinical decision-making (d=0.47 (0.23, 0.72)), ambulance times (d=0.43 (0.12, 0.74)) and survival rates (d=0.22 (0.11, 0.33)). The between-study heterogeneity variance was estimated at σ2=0.32 (95% CI 0.22, 0.50), with an I2value of 99% (95% CI 98%, 99%), indicating substantial statistical heterogeneity.ConclusionThis review demonstrated that the evidence base currently does not support a clear single point estimate of the pooled effect of feedback to EMS staff as a single intervention type due to study heterogeneity. Further research is needed to provide guidance and frameworks supporting better design and evaluation of feedback interventions within EMS.PROSPERO registration numberCRD42020162600.

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It’s Time to Talk to Prehospital Providers: Feedback Disparities among Ground-Based Emergency Medical Services Providers and its Impact on Job Satisfaction

Cited by 13 publications

References 13 publications

Prehospital Stroke Care, Paramedic Training Needs, and Hospital-Directed Feedback in Lithuania

Prehospital Stroke Care, Paramedic Training Needs, and Hospital-Directed Feedback in Lithuania

Prehospital Stroke Care, Paramedic Training Needs, and Hospital-Directed Feedback in Lithuania

Types and effects of feedback for emergency ambulance staff: a systematic mixed studies review and meta-analysis

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