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

Wilson, Caitlin; Janes, Gillian; Lawton, Rebecca; Benn, Jonathan

doi:10.1136/bmjqs-2022-015634

Cited by 10 publications

(16 citation statements)

References 144 publications

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Section: Discussionmentioning

confidence: 99%

“…(15) The beneficial impact of feedback on care processes that form part of the pre-alert processes, such as improving clinical decision making, protocol adherence and documentation was identified in a systematic review. (16) Two thirds of ambulance clinicians were in favour of further guidance about silver trauma. Older trauma patients have complex presentations and benefit from early review from a geriatrician.…”

Section: Comparison With Other Literaturementioning

confidence: 99%

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Variation in ambulance pre-alert process and practice: Cross-sectional survey of ambulance clinicians

Coster,

Sampson,

O’Hara

et al. 2023

Preprint

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BackgroundAmbulance clinicians use pre-alerts calls to alert emergency departments (EDs) about the arrival of critically ill patients. We explored ambulance clinician’s views and experiences of pre-alert practice and processes using a national online survey.MethodsAmbulance clinicians involved in pre-alert decision-making were recruited via ambulance trusts and social media to complete an anonymous online survey during May-July 2023. Quantitative data was analysed descriptively using SPSS and text data was analysed thematically to illustrate quantitative findings.ResultsWe included 1298 valid responses from across 10 ambulance services. Analysis identified variation in practice at all stages of the pre-alert process, including reported frequency of pre-alert (7.1% several times a shift, 14.9% once/twice a month).Most respondents reported that pre-alerts were delivered directly to the ED but 32.8% reported pre-alerting via an ambulance control room. Personal mobile phones were used to make a pre-alert by 46.8% of respondents, with 30% using ambulance radio. A third of respondents always used mnemonics (e.g. ATMIST/SBAR) but 10.2% reported not using any fixed format.Guidance used to identify patients for pre-alert varied between clinicians and ambulance service, with local ambulance service guidance most commonly used and 20% stating they never use national guidelines. Respondents reported variable understanding of appropriate conditions for pre-alert and particularly students wanted further guidance on silver trauma and medical pre-alerts.Only 29% or respondents reported receiving specific pre-alert training and 50% reported never receiving feedback. Fewer than 9% reported always being listened to and having the call taken seriously.ConclusionWe identified variation in pre-alert processes and practice that may result in inconsistent pre-alert practice and challenges for clinicians providing time critical care. Guidance and training on the use of pre-alerts may promote more consistent processes and practices.WHAT IS ALREADY KNOWN ON THIS TOPIC⍰ Pre-alerts can enable EDs to prepare for the arrival of a critically ill patient.⍰ There is variation in local ambulance trust pre-alert guidance, in terms of variation in the conditions suitable for pre-alert and alignment with the ACCE/RCEM pre-alert criteria.WHAT THIS STUDY ADDS⍰ The study identifies variation in reported practice in how pre-alerts are delivered across ambulance services and between individual clinicians.⍰ The study identifies a lack of formal training and feedback around pre-alerts and that a majority of ambulance clinicians would find additional training and feedback useful.HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY⍰ Training and guidance in the use of pre-alerts could promote more consistent processes and practices⍰ Further research is needed to better understand how to improve pre-alert practice and increase consistency.

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Section: Discussionmentioning

confidence: 99%

Section: Comparison With Other Literaturementioning

confidence: 99%

Variation in ambulance pre-alert process and practice: Cross-sectional survey of ambulance clinicians

Coster,

Sampson,

O’Hara

et al. 2023

Preprint

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“…18 For instance, reporting of errors or near misses may be low due to a perceived lack of psychological safety for the reporters and others involved in the patient safety event. 15 Formal review of errors in healthcare may also, at times, be considered negative or punitive, 19 with participants possibly fearing recrimination for their perceived shortcomings. As has been reported in medication safety incidents, this may in turn lead to under-reporting of error and patient safety events, hindering opportunities for improvement.…”

Section: Errormentioning

confidence: 99%

Advancing paramedicine: Error, accountability and patient safety

Meadley,

Humar,

Salathiel

et al. 2023

Paramedicine

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The consequences of human error range from the benign to the catastrophic. Feedback and formal review of failures in human performance are essential for learning and avoidance of harm in the future. However, anecdotal evidence suggests that paramedicine may sustain a culture where formal review of error may be considered punitive, hampering enhancements in care and professional maturity. With enhanced transparency of adverse events, mature review processes and acceptance and translation of recommendations, we look to a shift in the culture. Clinicians and organisations must be accountable for their role in review and audit of near misses and adverse events. There is a path forward for paramedicine, where courageous individuals are empowered to identify clinical error and speak up, promoting growth. We must prevent individual feelings of shame and fear of consequences. Only then can we see a true patient-centric safety culture in paramedicine, one which supports clinicians’ development.

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“…In this issue of the journal Wilson et al ’s7 systematic review and meta-analysis illustrates the important effects that feedback in the EMS can have on safety-relevant processes such as ambulance response times, protocol adherence and documentation. The review7 notes that the issue of feedback in EMS has been ‘relatively neglected’ and is still in its ‘infancy’. We argue that this is reflective of a wider lack of attention to the issue of patient safety in the EMS that is detrimental for both patients and EMS care providers.…”

Section: Introductionmentioning

confidence: 99%

“…However, patients and their families are often best placed to feedback on important elements of care including continuity of care, communication failures, and dignity and respect. Wilson et al ’s7 review notes a use of patient-outcome feedback across 10% of studies but these are data on patients rather than data from patients. Patient-experience feedback was considered in just 4% of studies.…”

Section: Introductionmentioning

confidence: 99%