Sampson Fiona C, O'Hara Rachel, Long Jaqui, Coster Joanne
The University of Sheffield, Sheffield, UK
The University of Sheffield, Sheffield, UK.
BMJ Open. 2025 Jan 20;15(1):e094221. doi: 10.1136/bmjopen-2024-094221.
Prehospital notifications (pre-alerts) enable emergency department (ED) staff to prepare for the arrival of patients requiring a time-critical response. Effective communication of the pre-alert is key to enabling the ED to prepare appropriately, but evidence on communication practices is lacking. We undertook qualitative research to understand how pre-alert communication may be improved to optimise the ED response for pre-alerted patients.
DESIGN, SETTING AND PARTICIPANTS: Data collection took place within three UK Ambulance Services and six EDs between August 2022 and April 2023. We undertook semi-structured interviews with 34 ambulance and 40 ED staff and 156 hours non-participation observation of pre-alert practice (143 pre-alerts). Verbatim interview transcripts and observation notes were imported into NVivo and analysed using a thematic approach.
We identified significant variation in how pre-alerts were communicated that influenced how effectively information was transferred. Ambulance and ED staff demonstrated a shared recognition that pre-alerts need to be communicated concisely, but both received minimal training in how to give and receive pre-alerts. Efficient pre-alerting was influenced by clinician experience and seniority. ED and ambulance clinicians following different information-sharing formats sometimes led to interruptions, information loss and tensions, particularly when an early 'headline' clinical concern had not been shared. Ambulance clinicians sometimes questioned the appropriateness of their pre-alert when ED clinicians did not explain the rationale for not giving the expected response (that is, being accepted into a high-priority area of the ED). Additional sources of frustration included technological problems and poor communication of estimated time of arrival and caller/responder identities.
Use of a shared format, including a headline 'cause for concern', may improve the clarity, usefulness and civility of pre-alerts, particularly when the clinician's concern is not obvious from observations. Basic training on how to undertake pre-alerts for both ED and ambulance clinicians may improve understanding of the importance of pre-alert communication.
ISRCTN12652860.
院前通知（预警报）可使急诊科（ED）工作人员为需要紧急响应的患者的到来做好准备。预警报的有效沟通是使急诊科能够进行适当准备的关键，但目前缺乏关于沟通实践的证据。我们进行了定性研究，以了解如何改进预警报沟通，从而优化急诊科对预警报患者的响应。
设计、设置和参与者：2022年8月至2023年4月期间，在英国的三个救护服务机构和六个急诊科收集数据。我们对34名救护人员和40名急诊科工作人员进行了半结构化访谈，并对143次预警报实践进行了156小时的非参与式观察。逐字记录的访谈转录本和观察笔记被导入NVivo，并采用主题分析法进行分析。
我们发现预警报的沟通方式存在显著差异，这影响了信息传递的有效性。救护人员和急诊科工作人员一致认为预警报需要简洁传达，但双方在如何发出和接收预警报方面接受的培训都很少。高效的预警报受到临床医生经验和资历的影响。遵循不同信息共享格式的急诊科和救护临床医生有时会导致中断、信息丢失和紧张关系，特别是当早期的“头条”临床问题未被共享时。当急诊科临床医生没有解释不给出预期响应（即被接纳到急诊科的高优先级区域）的理由时，救护临床医生有时会质疑他们预警报的适当性。其他令人沮丧的原因包括技术问题以及预计到达时间和呼叫者/响应者身份的沟通不畅。
使用包括“关注原因”头条的共享格式，可能会提高预警报的清晰度、有用性和礼貌性，特别是当从观察中临床医生的关注点不明显时。为急诊科和救护临床医生提供关于如何进行预警报的基础培训，可能会提高对预警报沟通重要性的理解。
ISRCTN12652860。
