Paramedic experiences of using an enhanced stroke assessment during a cluster randomised trial: a qualitative thematic analysis

Abstract

BackgroundIntravenous thrombolysis is a key element of emergency treatment for acute ischaemic stroke, but hospital service delivery is variable. The Paramedic Acute Stroke Treatment Assessment (PASTA) multicentre cluster randomised controlled trial evaluated whether an enhanced paramedic-initiated stroke assessment pathway could improve thrombolysis volume. This paper reports the findings of a parallel process evaluation which explored intervention paramedics’ experience of delivering the enhanced assessment.MethodsInterviewees were recruited from 453 trained intervention paramedics across three UK ambulance services hosting the trial: North East, North West and Welsh Ambulance Services. A semistructured interview guide aimed to (1) explore the stroke-specific assessment and handover procedures which were part of the PASTA pathway and (2) enable paramedics to share relevant views about expanding their role and any barriers/enablers they encountered. Interviews were audiorecorded, transcribed verbatim and analysed following the principles of the constant comparative method.ResultsTwenty-six interviews were conducted (11 North East, 10 North West and 5 Wales). Iterative data analysis identified four key themes, which reflected paramedics’ experiences at different stages of the care pathway: (1) Enhanced assessment at scene: paramedics felt this improved their skillset and confidence. (2) Prealert to hospital: a mixed experience dependent on receiving hospital staff. (3) Handover to hospital team: standardisation of format was viewed as the primary benefit of the PASTA pathway. (4) Assisting in hospital and feedback: due to professional boundaries, paramedics found these aspects harder to achieve, although feedback from the clinical team was valued when available.ConclusionParamedics believed that the PASTA pathway enhanced their skills and the emergency care of stroke patients, but a continuing clinical role postadmission was challenging. Future studies should consider whether interdisciplinary training is needed to enable more radical extension of professional boundaries for paramedics.

Identification Of Clinical Pathway Models To Prevent Complications And Improve The Quality Of Life Of Stroke Patients

“…The results of other studies state that ischemic stroke is caused by disruption of the blood supply to parts of the brain, while hemorrhagic stroke is caused by rupture of a blood vessel in the brain (Mead et al, 2023). Blood supply to parts of the brain or rupture of blood vessels causes brain cells to experience a lack of oxygen and nutrients, resulting in significant damage (Lally et al, 2020). If damage occurs to an area of the brain, nerve signals cannot be sent effectively to the muscles that control parts of the body, resulting in paralysis and/or speech disorders, and several other disorders (Almilaibary et al, 2022).…”

Do methods of hospital pre-alerts influence the on-scene times for acute pre-hospital stroke patients? A retrospective observational study

“…National changes to how ambulances are dispatched, and the centralisation of stroke care, could be expected to increase the amount of time it takes between the initial call for help and the arrival at CT scan ( Morris et al, 2014 ), however there have been no notable changes to how paramedics assess and treat acute stroke patients ( Lally et al, 2020 ; Sheppard et al, 2015 ). Due to this, the average times on scene should have remained static within NEAS, with the increased travel time accounting for the increasing time delays, however this was not found to be the case.…”

“…The Ambulance Quality Indicators ( NHS, 2019a ) audit all English ambulance services for stroke care, and have found the North East Ambulance Service NHS Foundation Trust (NEAS) to be performing below average for the time it takes the patient to arrive at the hospital following the original 999 call. In line with this, a service evaluation of on-scene times within NEAS was carried out and pre-hospital on-scene times for acute stroke patients were found to have risen year on year from 2011 to 2018, despite the limited interventions a pre-hospital clinician can implement prior to transport ( Haworth & McClelland, 2019 ; Lally et al, 2020 ). The findings stated that the average on-scene times increased yearly, with up to 30 minutes as the average time spent on scene in 2018.…”

Improving emergency treatment for patients with acute stroke: the PEARS research programme, including the PASTA cluster RCT

“…The main study report has been published. 52 Material throughout this section has been reproduced with permission from Lally et al 52 This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: https://creativecommons.org/licenses/by/4.0/.…”