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

Abstract

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.