Photo Credit: Ruslan Batiuk

The following is a summary of “What influences ambulance clinician decisions to pre-alert emergency departments: a qualitative exploration of pre-alert practice in UK ambulance services and emergency departments,” published in the July 2024 issue of Emergency Medicine by O’Hara et al.

Pre-alerts are crucial for timely patient care, but excessive pre-alerts can lead to resource misallocation and pre-alert fatigue among ED staff.

Researchers conducted a retrospective study to illuminate the process of pre-alert decision-making practice, an important pointer of emergency medical services. 

They meticulously conducted interviews with 34 ambulance clinicians and 40 ED staff and observed 162 hours of responses (n=143, call-to-handover) in 6 EDs. The interview transcripts were meticulously imported into NVIVO and analyzed using thematic analysis, ensuring a comprehensive understanding of the subject.

The results showed clinical judgment and risk of deterioration. Clinical experience with confidence helped ambulance clinicians to understand which patients required ED care or were at an increased risk of deterioration. Ambulance clinicians learned to pre-alert on the job by informal feedback, such as ED response. Variability in availability and access to clinical decision support was also observed. The challenging part for less experienced clinicians was between ambulance services and EDs, which created difficulties in deciding to be a pre-alert. 

Investigators concluded that avoidable variation in decision-making can impact patient care, emergency care resources, and inter-service relations and that standardization, training, and collaboration can improve consistency. 

Source: emj.bmj.com/content/early/2024/08/17/emermed-2023-213849