Coster Joanne E, Sampson Fiona C, O'Hara Rachel, Long Jaqui, Bell Fiona, Goodacre Steve
The University of Sheffield, Sheffield Centre for Health and Related Research (SCHARR), Sheffield, UK
The University of Sheffield, Sheffield Centre for Health and Related Research (SCHARR), Sheffield, UK.
Emerg Med J. 2024 Dec 30;42(1):14-20. doi: 10.1136/emermed-2023-213851.
Ambulance clinicians use pre-alert calls to inform emergency departments (EDs) about the arrival of critically ill patients. However, there is variation in guidance between local ambulance service policies in terms of what should be pre-alerted and how pre-alerts should happen. We conducted a national online survey to understand the use of ambulance pre-alerts and to inform recommendations for practice and guidance.
Ambulance clinicians in England involved in pre-alert decision-making were recruited via ambulance trusts and social media to complete an anonymous online survey conducted during May-July 2023. Quantitative data was analysed descriptively using SPSS (version 28) and free-text responses are reported to illustrate the quantitative findings.
We included 1298 valid responses from 10 English ambulance services. There was variation in practice at all stages of the pre-alert process, including the reported frequency of pre-alert (7.1% several times a shift, 14.9% once/two times per month). Most respondents reported that pre-alerts were delivered directly to the ED, but 32.8% reported pre-alerting via an ambulance control room. A third of respondents always used mnemonics to guide a pre-alert (eg, ATMIST (Age, Time of Incident, Mechanism of injury, Injuries, Signs, Treatments)), but 10.2% reported not using any fixed format.The type of guidance used to identify patients for pre-alert varied between clinicians and ambulance services, with local ambulance service guidance being most commonly used, and 20% stating they never use national guidelines. Respondents reported variable understanding of appropriate conditions for pre-alert, with paramedic students particularly wanted further guidance on trauma in older patients and medical pre-alerts. 29% of respondents reported receiving specific pre-alert training, while 50% reported never receiving feedback.
We identified variation in pre-alert processes and practices that may result in uncertainty and challenges for ambulance clinicians providing time-critical care. Guidance and training on the use of pre-alerts may promote more consistent processes and practices.
救护车临床医生通过预报警电话告知急诊科（ED）危重症患者即将到达。然而，各地救护车服务政策在应预报警的内容以及预报警的方式上存在差异。我们开展了一项全国性在线调查，以了解救护车预报警的使用情况，并为实践和指南提供建议。
通过救护车信托机构和社交媒体招募参与英格兰预报警决策的救护车临床医生，以完成2023年5月至7月期间进行的一项匿名在线调查。使用SPSS（版本28）对定量数据进行描述性分析，并报告自由文本回复以阐明定量结果。
我们纳入了来自10个英格兰救护车服务机构的1298份有效回复。预报警过程的各个阶段在实践中都存在差异，包括报告的预报警频率（7.1%每班数次，14.9%每月一次/两次）。大多数受访者报告称预报警直接发送至急诊科，但32.8%的受访者报告通过救护车控制室进行预报警。三分之一的受访者总是使用助记符来指导预报警（例如，ATMIST（年龄、事件时间、受伤机制、损伤、体征、治疗）），但10.2%的受访者报告未使用任何固定格式。用于识别预报警患者的指导类型在临床医生和救护车服务机构之间各不相同，当地救护车服务指南使用最为普遍，20%的受访者表示他们从不使用国家指南。受访者报告对预报警的适当情况理解不一，护理专业学生尤其希望获得关于老年患者创伤和医疗预报警的进一步指导。29%的受访者报告接受过特定的预报警培训，而50%的受访者报告从未收到过反馈。
我们发现预报警流程和实践存在差异，这可能给提供紧急护理的救护车临床医生带来不确定性和挑战。关于预报警使用的指南和培训可能会促进更一致的流程和实践。
