Emergency medicine journal : EMJ
-
Over the last decade there has been a steadily increasing demand for unscheduled healthcare services, including the ambulance services. To address this demand, various projects have been developed to reduce admissions to the emergency department. One of these was the introduction of Treat and Refer (T&R) guidelines, to allow ambulance clinicians to treat certain groups of patients in the community without the need to convey them to hospital. ⋯ This study and the supporting literature do not support the use of T&R guidelines in their current format by traditionally trained ambulance clinicians. Ambulance clinicians have identified the need for further education and support. The conceptual support for T&R may provide a foundation to develop and improve the education and support for ambulance clinicians. This should be combined with implementation/review strategies, clinician-led decision support and management support which can provide the ambulance clinician with the skills and confidence to take responsibility for non-conveyance.
-
Response times have been used as a key quality indicator for emergency ambulance services in the United Kingdom, but criticised for their narrow focus. Consequently, there is a need to consider wider measures of quality. The patient perspective is becoming an increasingly important dimension in pre-hospital outcomes research. To that end, we aimed to investigate patients' experiences of the 999 ambulance service to understand the processes and outcomes important to them. ⋯ Aspects other than response times were important to patients, particularly in situations perceived by patients to be non-emergency. The results will be combined with issues identified from systematic reviews and used in a Delphi study to identify candidates for new outcome measures for emergency ambulance services.
-
The paramedic profession, along with the broader structure and mission of NHS emergency ambulance provision, is undergoing significant but rather undefined change. The clinical scope of the paramedic role has broadened, and the opening of new patient pathways has enabled a broader range of treatment and referral options for attending ambulance crews. Ambulance trusts have moved to an all-graduate intake for new paramedics, and significant advances have been made in establishing the classic steps of a 'professionalization project' (such as the growth of the College of Paramedics, the development of peer-reviewed practitioner journals, and the introduction of advanced paramedic roles.) Some of these changes are contentious, however, and many of the fundamentals of ambulance work and occupational culture remain unchanged to a significant degree. ⋯ Based on qualitative interviews and ethnographic observation of ambulance crews and of mid-level ambulance trust managers, the paper provides an in-depth exploration of the culture of everyday working life in (anonymized) ambulance trusts. We identify several broad conceptions among staff as to the essence and purpose of emergency ambulance provision, of ambulance trusts as employers, and of the goals and potential pitfalls of the professionalization project. The paper thus explores the multifaceted meanings of 'professionalism' and considers the broad challenges facing the profession at large and NHS trusts as employers as both confront unsettling forms of change.
-
Falls occur increasingly frequently with age. 35% of people aged over 65 fall each year rising to 50% at age 85. Many patients fall repeatedly. 56% of patients attending an emergency department were recurrent fallers, and 55% of patients presenting with an acute fracture had previously fallen. Fracturing bones is closely linked to falling and carries great costs both for the NHS and the individual. ⋯ GPs are quite often aware of their frequent falling patients, home adaptations had been made, often are already taking medications for osteoporosis, they have personal alarms, home carers who visited frequently and fall assessments had been carried out. Additionally, paramedics felt that some patients do not want to be helped and felt there is a limit to what can be done to prevent people from falling in their own homes. This presentation will provide an insight into the levels of care and professionalism that paramedics demonstrate when attending people who fall in everyday practice.
-
The Welsh Government's strategy to improve Chronic Conditions Management includes improving care coordination and patient self-management to reduce unscheduled care use. Welsh health boards have responsibility for implementing the strategy since 2008. In 2011, integrated working between health and social care professionals was piloted in Carmarthenshire, part of Hywel Dda Health Board. ⋯ People with multiple and complex chronic conditions appear confident about self managing their health. Integrated working across providers seems to work best for patients who are least or most ill; otherwise people with multiple conditions complain that care is disease-specific not patient-focused. Accessing treatment should be considered as a component of care because difficult travel arrangements are preventing people attending appointments.