This paper reports on a qualitative study that appears to have been motivated, in part, by a need to develop patient reported experience measures (PREMs) suitable for use in pre-hospital care. It is a valuable addition to our understanding of both patients' and clinicians' experiences of pre-hospital care for individuals with suspected stroke or acute myocardial infarction (AMI).
To be eligible for inclusion in the study, patients had to have experienced emergency ambulance service care for either a suspected stroke or AMI in the previous 12 months. All participants were given the option of participating in a focus group or an individual interview (five ambulance staff opted for a focus group). It would be interesting to know why the researchers offered a choice and whether they found a difference in the type and/or nature of data collected between the different methods.
Overall, the authors state that 22 patients and 17 ambulance staff (total 39) were recruited to the study. However, there is a slight discrepancy in the abstract where it is reported that 33 semi-structured interviews were undertaken plus one focus group with five clinicians, making a total of 38 participants.
All three authors engaged in the analysis of data which was informed by a thematic network approach. Four key themes emerged: communication; treatment; professionalism; and transition from home to hospital.
The authors provide a range of verbatim quotes from both patients and clinicians to illustrate the key themes before moving on to a focussed discussion of the findings. Overall, while there were many similarities within the data, there were also some stark differences that emerged from the analysis.
One example involves a subtheme of communication which is termed: ‘explanation of condition’. There were differences between the patients as to whether or not a diagnosis should be given in the pre-hospital environment with one patient receiving a diagnosis of suspected stroke stating that this put ‘their mind at rest’, while another patient suspected of AMI said ‘I wouldn't have wanted to hear that [diagnosis] unless I was in hospital’. Equally, there were differences among the ambulance staff with some staff believing that the patients expected them to give a provisional diagnosis while another view reflected a belief that this was the responsibility of the medical profession.
One interesting observation related to a mismatch between ambulance staff's perceptions of patients' expectations of pre-hospital treatment, and what the patients actually reported. One patient indicated that they had absolutely no idea what an ambulance crew were supposed to do, while a clinician described that patients are frequently fully informed about pre-hospital care. Another difference between staff and patients' perspectives that emerged, involved the actual journey to hospital. Ambulance staff identified that the condition of the ambulance was unlikely to bother patients or relatives, but some of the patients reported in the interviews that they were surprised at the condition of the vehicle describing it as ‘uncomfortable’, ‘noisy’, ‘old’ and so on.
In summary, and not surprisingly in some ways, patients reported enhanced experiences of pre-hospital care when there was evidence of effective communication, focussed and controlled attention to treatment, practitioner competence which was embedded in the theme of ‘professionalism’, and a smooth transition between care in the ambulance service and the hospital. If ambulance staff addressed the patients' emotional and social needs as well as their physical needs, this contributed to a higher level of reported satisfaction by patients.
This study stands as a fascinating piece of research, providing the reader with an insight into patients' experiences of this part of their journey through the healthcare system. As well as having value as a study in its own right that potentially broadens our awareness of some patients' experiences of pre-hospital care in suspected stroke or AMI, the authors identify that the findings will inform development of PREM questionnaires for pre-hospital care which will subsequently be subjected to further research to assess their reliability and validity.