Lederman Jakob, Löfvenmark Caroline, Djärv Therese, Lindström Veronica, Elmqvist Carina
Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
Academic Emergency Medical Service, Region Stockholm, Stockholm, Sweden.
BMJ Open. 2019 Sep 24;9(9):e030203. doi: 10.1136/bmjopen-2019-030203.
To combat overcrowding in emergency departments, ambulance clinicians (ACs) are being encouraged to make on-site assessments regarding patients' need for conveyance to hospital, and this is creating new and challenging demands for ACs. This study aimed to describe ACs' experiences of assessing non-conveyed patients.
A phenomenological interview study based on a reflective lifeworld research approach.
The target area for the study was Stockholm, Sweden, which has a population of approximately 2.3 million inhabitants. In this area, 73 ambulances perform approximately just over 200 000 ambulance assignments annually, and approximately 25 000 patients are non-conveyed each year.
11 ACs.
In-depth open-ended interviews.
ACs experience uncertainty regarding the accuracy of their assessments of non-conveyed patients. In particular, they fear conducting erroneous assessments that could harm patients. Avoiding hasty decisions is important for conducting safe patient assessments. Several challenging paradoxes were identified that complicate the non-conveyance situation, namely; responsibility, education and feedback paradoxes. The core of the responsibility paradox is that the increased responsibility associated with non-conveyance assessments is not accompanied with appropriate organisational support. Thus, frustration is experienced. The education paradox involves limited and inadequate non-conveyance education. This, in combination with limited support from non-conveyance guidelines, causes the clinical reality to be perceived as challenging and problematic. Finally, the feedback paradox relates to the obstruction of professional development as a result of an absence of learning possibilities after assessments. Additionally, ACs also described loneliness during non-conveyance situations.
This study suggests that, for ACs, performing non-conveyance assessments means experiencing a paradoxical professional existence. Despite these aggravating paradoxes, however, complex non-conveyance assessments continue to be performed and accompanied with limited organisational support. To create more favourable circumstances and, hopefully, safer assessments, further studies that focus on these paradoxes and non-conveyance are needed.
为应对急诊科过度拥挤的情况，鼓励救护车临床医生（ACs）对患者是否需要送往医院进行现场评估，这给ACs带来了新的挑战性要求。本研究旨在描述ACs评估非转运患者的经历。
一项基于反思性生活世界研究方法的现象学访谈研究。
研究的目标区域是瑞典斯德哥尔摩，人口约230万。在该地区，73辆救护车每年执行约20多万次救护车任务，每年约有25000名患者未被转运。
11名ACs。
深度开放式访谈。
ACs对非转运患者评估的准确性感到不确定。特别是，他们担心做出错误的评估会伤害患者。避免仓促决策对于进行安全的患者评估很重要。发现了几个具有挑战性的悖论，使非转运情况变得复杂，即责任、教育和反馈悖论。责任悖论的核心是，与非转运评估相关的责任增加，但没有得到适当的组织支持。因此，会感到沮丧。教育悖论涉及有限且不足的非转运教育。这与非转运指南的支持有限相结合，导致临床实际情况被认为具有挑战性和问题性。最后，反馈悖论与评估后缺乏学习机会导致职业发展受阻有关。此外，ACs还描述了非转运情况下的孤独感。
本研究表明，对于ACs来说，进行非转运评估意味着经历一种矛盾的职业状态。然而，尽管存在这些加剧的悖论，复杂的非转运评估仍在继续进行，且组织支持有限。为了创造更有利的环境，并有望进行更安全的评估，需要进一步研究这些悖论和非转运情况。
