Schneider Katherine, Williams Mimi, Mohr Nicholas M, Ahmed Azeemuddin
Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa.
Prehosp Emerg Care. 2024;28(5):735-744. doi: 10.1080/10903127.2024.2324970. Epub 2024 Mar 12.
Emergency medical services (EMS) clinicians experience dissatisfaction with the quality and quantity of clinical feedback from hospitals. Satisfaction is further diminished by the lack of a standardized systems approach. The purpose of this study was to identify rural clinicians' perceptions and preferences regarding clinical feedback received from hospitals, the delivery mechanisms, and its impact on their relationships with health care organizations.
This was a qualitative study focused on EMS clinicians involved in rural prehospital care at a single Midwestern academic medical center. Using a phenomenological framework, semi-structured interviews were conducted with medical directors, service directors, fire captains, air medical personnel, emergency medical responders, emergency medical technicians, advanced emergency medical technicians, and paramedics, all of whom were selected through purposive sampling. Interviews were recorded, transcribed, and independently coded by two trained reviewers.
Twenty participants (11 frontline clinicians and 9 administrative staff members) with a wide range of clinical experience from 14 air and ground EMS agencies were interviewed. Emerging themes included: (1) the value or usefulness of feedback; (2) desired feedback system characteristics; (3) barriers to receiving feedback; (4) utilization and application of feedback; and (5) the feedback's impact on the relationship with health care organizations. Participants felt that clinical feedback from hospitals was especially important as a method of improving quality of care, though was rarely provided. Professional development was seen as a major benefit of receiving clinical feedback from hospitals.
Our results suggest that consistent clinical feedback provided by hospitals was valued. Establishing a culture of providing organized feedback to practicing rural EMS clinicians is important for professional development and can strengthen the relationships between EMS clinicians and hospitals. These study findings can assist in the development and implementation of a standardized feedback instrument to benefit rural EMS clinicians, patients, and the health care system as a whole.
紧急医疗服务（EMS）临床医生对来自医院的临床反馈的质量和数量感到不满。缺乏标准化的系统方法进一步降低了满意度。本研究的目的是确定农村临床医生对从医院收到的临床反馈、反馈传递机制及其对他们与医疗保健组织关系的影响的看法和偏好。
这是一项定性研究，重点关注中西部一家学术医疗中心参与农村院前护理的EMS临床医生。采用现象学框架，对医疗主任、服务主任、消防队长、空中医疗人员、急救人员、急救医疗技术员、高级急救医疗技术员和护理人员进行了半结构化访谈，所有这些人员均通过目的抽样选取。访谈进行了录音、转录，并由两名经过培训的评审员独立编码。
对来自14个空中和地面EMS机构、具有广泛临床经验的20名参与者（11名一线临床医生和9名行政人员）进行了访谈。出现的主题包括：（1）反馈的价值或有用性；（2）期望的反馈系统特征；（3）接收反馈的障碍；（4）反馈的利用和应用；以及（5）反馈对与医疗保健组织关系的影响。参与者认为，医院的临床反馈作为提高护理质量的一种方法尤为重要，尽管很少提供。专业发展被视为从医院获得临床反馈的一项主要益处。
我们的结果表明，医院提供的一致临床反馈是有价值的。建立一种向农村EMS执业临床医生提供有组织反馈的文化对于专业发展很重要，并且可以加强EMS临床医生与医院之间的关系。这些研究结果有助于开发和实施标准化的反馈工具，以使农村EMS临床医生、患者和整个医疗保健系统受益。
