Decision-making by ambulance clinicians in London when managing patients with epilepsy: a qualitative study
- 1Faculty of Health and Social Care, Kingston University and St George's University of London, London, UK
- 2Institute of Psychiatry, King’s College London, London, UK
- Correspondence to Lisa Burrell (formerly Hollings), Kingston and St George's University of London, Cranmer Terrace, London SW17 0RE, UK;
Contributors LB, AN and LR designed the study. LB prepared the data, completed the first analysis and wrote the first draft. AN and LR helped further refine the analysis and contributed to further drafts. LR is the guarantor. All authors had full access to all the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.
- Accepted 12 February 2012
- Published Online First 20 March 2012
Background In the UK, epilepsy is the neurological condition with the highest rate of accident and emergency department re-attendance, with most arriving by ambulance. Ambulance clinicians triage patients and assess their need for attendance. This study examined the decision-making process of ambulance clinicians in these situations.
Methods In-depth interviews with 15 ambulance clinicians working in South London.
Results Interviewees identified that epileptic seizures that self-resolve present a triage challenge. They reported insufficient training and guidance available for these situations and substantial reliance on experience to direct their practice. Fears of litigation in the event of complications, pressures of public expectation and limited on-scene access to relevant patient information or appropriate alternative care pathways were reported to be significant factors influencing decisions for care for epilepsy seizures.
Discussion Ambulance clinicians reported negotiating a balance between patient safety and patient choice, when deciding whether to transport a patient with epilepsy to hospital or not. Clinician fears and the pressures and limitations of practice may result in hospital conveyance being used as a safety precaution in some instances.
Conclusions Decisions regarding conveyance of patients with epilepsy in this study were substantially guided by ambulance clinician experience rather than by robust training and guidelines. This study supports the need for improved guidance that addresses this common area of practice and the development of alternative care pathways that may be used by ambulance clinicians for patients with epilepsy.
- emergency ambulance systems
- clinical management
Funding The study was supported by a National Institute for Health Research Service Delivery and Organisation (NIHR SDO) grant (08/1815/234). The funders had no role in the design or conduct of this review, or in the preparation, review, or approval of the manuscript. All authors carried out this research independently of funding bodies. This study was completed by LB in part requirement for an MSc in Clinical Neuroscience at King's College London.
Competing interests The authors declare: (1) no financial support for the submitted work from National Institute for Health Research Service Delivery and Organisation Programme; (2) no financial relationships with commercial entities that might have an interest in the submitted work; (3) no spouses, partners or children with relationships with commercial entities that might have an interest in the submitted work; and (4) no non-financial interests that may be relevant to the submitted work.
Ethics approval The National Research Ethics Service considered this study did not require ethical approval. Approval granted by the London Ambulance Service Clinical Audit and Research Department reference number LAS/SE/2010/05. Permission was obtained from the London Ambulance Service Clinical Audit and Research group for research to be conducted and submitted for publication (ref number LAS/SE/2010/05). Informed consent was obtained from individual participants.
Provenance and peer review Not commissioned; externally peer reviewed.