Faculty of Health and Applied Sciences, University of the West of England, Glenside Campus, Blackberry Hill, Bristol, BS16 1DD, UK.
Research Design Service, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
BMC Emerg Med. 2020 Jan 29;20(1):6. doi: 10.1186/s12873-020-0306-6.
Paramedics are increasingly required to make complex decisions as to whether they should convey a patient to hospital or manage their condition at the scene. Dementia can be a significant barrier to the assessment process. However, to our knowledge no research has specifically examined the process of decision-making by paramedics in relation to people with dementia. This qualitative study was designed to investigate the factors influencing the decision-making process during Emergency Medical Services (EMS) calls to older people with dementia who did not require immediate clinical treatment.
This qualitative study used a combination of observation, interview and document analysis to investigate the factors influencing the decision-making process during EMS calls to older people with dementia. A researcher worked alongside paramedics in the capacity of observer and recruited eligible patients to participate in case studies. Data were collected from observation notes of decision-making during the incident, patient care records and post incident interviews with participants, and analysed thematically.
Four main themes emerged from the data concerning the way that paramedics make conveyance decisions when called to people with dementia: 1) Physical condition; the key factor influencing paramedics' decision-making was the physical condition of the patient. 2) Cognitive capacity; most of the participants preferred not to remove patients with a diagnosis of dementia from surroundings familiar to them, unless they deemed it absolutely essential. 3) Patient circumstances; this included the patient's medical history and the support available to them. 4) Professional influences; participants also drew on other perspectives, such as advice from colleagues or information from the patient's General Practitioner, to inform their decision-making.
The preference for avoiding unnecessary conveyance for patients with dementia, combined with difficulties in obtaining an accurate patient medical history and assessment, mean that decision-making can be particularly problematic for paramedics. Further research is needed to find reliable ways of assessing patients and accessing information to support conveyance decisions for EMS calls to people with dementia.
护理人员越来越需要做出复杂的决策，决定是否将患者送往医院或在现场对其进行治疗。痴呆症可能是评估过程中的一个重大障碍。但是，据我们所知，没有研究专门探讨护理人员在处理痴呆症患者时的决策过程。本定性研究旨在调查影响对不需要立即进行临床治疗的老年痴呆症患者进行紧急医疗服务（EMS）呼叫时决策过程的因素。
本定性研究采用观察、访谈和文档分析相结合的方法，调查了影响对老年痴呆症患者进行 EMS 呼叫时决策过程的因素。一名研究人员以观察员的身份与护理人员一起工作，并招募符合条件的患者参加案例研究。数据来自事件期间决策观察记录、患者护理记录以及对参与者的事后访谈，并用主题分析法进行分析。
从关于护理人员在接到痴呆症患者电话时进行转院决策的方式的数据分析中得出了四个主要主题：1）身体状况；影响护理人员决策的关键因素是患者的身体状况。2）认知能力；大多数参与者宁愿不将被诊断为痴呆症的患者从他们熟悉的环境中带走，除非他们认为这是绝对必要的。3）患者情况；这包括患者的病史和他们可获得的支持。4）专业影响；参与者还参考了其他观点，如同事的建议或患者的全科医生提供的信息，以协助他们做出决策。
对于痴呆症患者避免不必要的转院的偏好，再加上获取准确的患者病史和评估的困难，这意味着护理人员在决策时可能会遇到特别的问题。需要进一步的研究来寻找可靠的方法来评估患者并获取信息，以支持对痴呆症患者的 EMS 呼叫的转院决策。
