“A call for a clear assignment” – A focus group study of the ambulance service in Sweden, as experienced by present and former employees

Rosén, Helena; Persson, Johan; Rantala, Andreas; Behm, Lina

doi:10.1016/j.ienj.2017.07.003

Cited by 18 publications

(28 citation statements)

References 24 publications

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“…In relation to non-conveyance, the current educational focus during specialist nurse training is perceived as obsolete and only prepares ACs for a limited part of their upcoming clinical reality: caring for acutely sick patients. Similar results have been reported previously, although not specifically from a non-conveyance context 12 30 38. Additionally, our results offer an in-depth insight regarding the clinical consequences of inadequate non-conveyance education.…”

Section: Discussionsupporting

confidence: 90%

“…However, partly as a result of overcrowding in EDs,10 alternative care pathways such as ‘see and convey elsewhere’ (ie, transporting patients to primary healthcare units or minor injury care units) and ‘non-conveyance’ (see and treat, see and refer) have been introduced in the last decade 9 11. This has placed new and challenging demands on ambulance services and, thus, ACs 12. Accumulating research is emphasising the need for in-depth knowledge regarding the assessments that lead to non-conveyance decisions 13 14.…”

Section: Introductionmentioning

confidence: 99%

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Assessing non-conveyed patients in the ambulance service: a phenomenological interview study with Swedish ambulance clinicians

et al. 2019

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ObjectivesTo combat overcrowding in emergency departments, ambulance clinicians (ACs) are being encouraged to make on-site assessments regarding patients’ need for conveyance to hospital, and this is creating new and challenging demands for ACs. This study aimed to describe ACs’ experiences of assessing non-conveyed patients.DesignA phenomenological interview study based on a reflective lifeworld research approach.SettingThe target area for the study was Stockholm, Sweden, which has a population of approximately 2.3 million inhabitants. In this area, 73 ambulances perform approximately just over 200 000 ambulance assignments annually, and approximately 25 000 patients are non-conveyed each year.Informants11 ACs.MethodsIn-depth open-ended interviews.ResultsACs experience uncertainty regarding the accuracy of their assessments of non-conveyed patients. In particular, they fear conducting erroneous assessments that could harm patients. Avoiding hasty decisions is important for conducting safe patient assessments. Several challenging paradoxes were identified that complicate the non-conveyance situation, namely; responsibility, education and feedback paradoxes. The core of the responsibility paradox is that the increased responsibility associated with non-conveyance assessments is not accompanied with appropriate organisational support. Thus, frustration is experienced. The education paradox involves limited and inadequate non-conveyance education. This, in combination with limited support from non-conveyance guidelines, causes the clinical reality to be perceived as challenging and problematic. Finally, the feedback paradox relates to the obstruction of professional development as a result of an absence of learning possibilities after assessments. Additionally, ACs also described loneliness during non-conveyance situations.ConclusionsThis study suggests that, for ACs, performing non-conveyance assessments means experiencing a paradoxical professional existence. Despite these aggravating paradoxes, however, complex non-conveyance assessments continue to be performed and accompanied with limited organisational support. To create more favourable circumstances and, hopefully, safer assessments, further studies that focus on these paradoxes and non-conveyance are needed.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Assessing non-conveyed patients in the ambulance service: a phenomenological interview study with Swedish ambulance clinicians

et al. 2019

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“…The RMS also expressed that they did not want to be "gatekeepers" to the healthcare facilities and saw a risk that some patients would take the opportunity to get a "physician consultation" free of charge. This concern is similar to findings by Rosén et al [18]. In focus group interviews with nurses in ambulance care, informants hinted that some patients could have another agenda when calling the ambulance service, such as that some patients see the ambulance services as a mobile care facility for obtaining an immediate assessment.…”

Section: Discussionsupporting

confidence: 79%

The Experience of Using Video Support in Ambulance Care: An Interview Study with Physicians in the Role of Regional Medical Support

et al. 2020

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Background: In order to facilitate more effective patient assessment and diagnostic support by improving the flow of information between ambulance nurses (AN) and physicians in the role of regional medical support (RMS), an application was developed for transmitting real-time video images. Objective: The objective of this study was to elucidate the physicians’ experiences using a video application to support the assessment and triage procedure in ambulance care, when patients are deemed to not have an urgent need for emergency care. Design: The design for this research was a qualitative interview study. Ten physicians, working as RMS in ambulance care, were purposively selected to participate. The telemedicine concept studied consisted of a real-time video image application, in addition to the currently used mobile phone. When a patient was deemed eligible for inclusion in the study, the ambulance nurse (AN) contacted the RMS via telephone to initiate a video consultation. To elucidate the RMS experience of using the application, a conventional content analysis was performed. Results: The main theme “a feeling of being satisfied through a sense of increased patient safety” emerged from the following two categories: adds value in diagnosing situations (three subcategories, i.e., support in diagnosing, usability, and technical weakness) and increase communication opportunities (four subcategories, i.e., assessing the level of care, patient dialogue, professional communication, and team learning). Conclusions: Physicians in the role of RMS experienced a positive impact using video image transmission in addition to the currently used mobile phone. This evaluation was derived from a sense of increased patient safety in the assessment situation when patients were considered to be triaged to self-care.

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“…However, it is not always a matter of course that CPG exists or are used as intended. A focus group study indicated that EMS CPGs focus on patients with acute medical needs and that CPGs for non-urgent patients was lacking (23). A cross-sectional study indicated a lack of both EMS and ED CPGs for patients with acute abdominal conditions (24).…”

Section: Clinical Practice Guidelinesmentioning

confidence: 99%

Quality Evaluation of Clinical Practice Guidelines for Comprehensive Patient Assessment in Emergency Care: A National Cross-sectional Survey

Falchenberg¹,

Andersson²,

Sundström³

et al. 2020

Preprint

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Background Clinical practice guidelines (CPGs) provide guidance for emergency care clinicians to perform patient assessments. Neglecting CPGs may lead to incomplete or fragmented assessments and cause ad-verse events. However, it is important for CPGs to be evidence based, and patient assessments must be conducted in such a manner that high levels of patient safety can be achieved. The aim of this study was to explore and evaluate the quality of emergency medical services (EMS) and emer-gency departments (EDs) CPGs for comprehensive patient assessments. Methods A national cross-sectional design was used, and the listed managers from 97 organizations (25 EMS and 72 EDs) were contacted, covering all 20 Swedish county councils. Fifteen guidelines were ap-praised using the validated Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool. Results The results revealed that none of the CPGs outlined a comprehensive patient assessment. The main characteristic of the CPGs was their focus on the medical assessment of patients with life-threatening conditions, mostly based on initial assessment and the A-E principle (airway, breathing, circulation, disability, and exposure). According to the AGREE II analysis, the overall quality of the guidelines was poor. CPGs lacked scientific support, underlying evidence, descriptions of how that evidence was collected, and explanations of the criteria used for CPG development. Conclusions This research indicated that there were no Swedish CPGs with comprehensive patient assessments in emergency care and that the foundation for evidence-based CPGs for comprehensive patient assessments was weak.

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“A call for a clear assignment” – A focus group study of the ambulance service in Sweden, as experienced by present and former employees

Cited by 18 publications

References 24 publications

Assessing non-conveyed patients in the ambulance service: a phenomenological interview study with Swedish ambulance clinicians

Assessing non-conveyed patients in the ambulance service: a phenomenological interview study with Swedish ambulance clinicians

The Experience of Using Video Support in Ambulance Care: An Interview Study with Physicians in the Role of Regional Medical Support

Quality Evaluation of Clinical Practice Guidelines for Comprehensive Patient Assessment in Emergency Care: A National Cross-sectional Survey

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