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decision-making
assessment
care pathway

Decision making for patients categorised as ‘amber’ in a rural setting

02 June 2019
Features
02 June 2019
Volume 11 · Issue 6

Abstract

Background:

Reducing unnecessary conveyances to hospital can help relieve pressure on emergency departments. Making decisions about conveyance in rural areas is particularly challenging because of the travel distances involved.

Aims:

To explore perceptions of paramedics in a rural setting about how they make decisions regarding conveyance and non-conveyance for patients categorised as ‘amber’ (serious but not life-threatening).

Methods:

Data were collected through interviews with 17 paramedics working in rural areas, which were analysed using inductive thematic analysis.

Findings:

Paramedics perceive hospitals as places of safety for themselves (psychological safety) and for patients (patient safety). Lower levels of psychological safety (e.g. because of an organisational blame culture) and perceived increased risks to patient safety (e.g. because of a lack of health resources in the community) influence paramedic decision making on conveying patients to hospital.

Conclusion:

Current practice contributes to increasing pressures on emergency departments. Ambulance services should work towards a non-punitive culture of safety where paramedics feel they can make decisions based on their experience and expertise rather than to protect themselves.

Patients waiting in ambulances outside emergency departments (EDs)—known as ambulance ramping or access blocking (Cameron and Campbell, 2003; Forero et al, 2011)—is a public-facing issue for the NHS in England and Wales. This is fuelled by increasing demand and an ageing population that requires more complex care. Minimising the number of unnecessary conveyances to hospital is a strategy to reduce delays and overcrowding (O'Cathain et al, 2018). The potential for paramedics delivering patient care away from the ED has been recognised (Auditor General for Wales, 2013). However, this requires appropriate use of ambulance resources (Snooks et al, 1998; Dejean et al, 2016) and the delivery of enhanced patient care at scene (NHS England, 2015).

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Ambulance
Decision making
Conveyance
Patient safety
Psychological safety
Emergency department