This paper presents findings from the qualitative component of a mixed-method study which included development and implementation of a ‘clinical assessment tool’ (CAT) designed to assist ambulance staff in their assessment and management (including conveyance decisions) of elderly people who have fallen.
Following the six-month trial of the CAT, 12 staff (1 paramedic; 11 emergency medical technicians) participated in semi-structured interviews which were recorded and transcribed. The data were subjected to rigorous thematic analysis with similarities emerging in relation to the overall assessment process which was divided into four stages: prearrival; initial contact; continuing assessment; making a conveyance decision.
Findings highlight the complexities involved in patient management decisions about conveyance, or not, of older people who fall, with evidence amongst the participants of utilisation of two models of decision-making: formal (based on policy and established procedures within the trust); and informal (based on intuition and experience).
The researchers acknowledge the limitations of the small sample size, but it was interesting to note a reluctance to use the CAT directly to inform clinical decision-making (the CAT documentation was often filled in retrospectively), with participants indicating that it only mirrored processes routinely undertaken in patient assessment anyway.
Clearly a valuable study highlighting areas for further research both into factors influencing clinical decision-making as well as exploring the impact of new care pathways offering alternatives to conveyance to emergency departments.
