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Paramedic experiences of using an enhanced stroke assessment during a cluster randomised trial: a qualitative thematic analysis
  1. Joanne Lally1,
  2. Anu Vaittinen1,
  3. Graham McClelland2,
  4. Christopher I Price3,
  5. Lisa Shaw3,
  6. Gary A Ford4,
  7. Darren Flynn1,
  8. Catherine Exley1
  1. 1 Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
  2. 2 Research and Development, North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, UK
  3. 3 Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
  4. 4 Medical Sciences Division, University of Oxford, and Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
  1. Correspondence to Christopher I Price, Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK; c.i.m.price{at}ncl.ac.uk

Abstract

Background Intravenous thrombolysis is a key element of emergency treatment for acute ischaemic stroke, but hospital service delivery is variable. The Paramedic Acute Stroke Treatment Assessment (PASTA) multicentre cluster randomised controlled trial evaluated whether an enhanced paramedic-initiated stroke assessment pathway could improve thrombolysis volume. This paper reports the findings of a parallel process evaluation which explored intervention paramedics’ experience of delivering the enhanced assessment.

Methods Interviewees were recruited from 453 trained intervention paramedics across three UK ambulance services hosting the trial: North East, North West and Welsh Ambulance Services. A semistructured interview guide aimed to (1) explore the stroke-specific assessment and handover procedures which were part of the PASTA pathway and (2) enable paramedics to share relevant views about expanding their role and any barriers/enablers they encountered. Interviews were audiorecorded, transcribed verbatim and analysed following the principles of the constant comparative method.

Results Twenty-six interviews were conducted (11 North East, 10 North West and 5 Wales). Iterative data analysis identified four key themes, which reflected paramedics’ experiences at different stages of the care pathway: (1) Enhanced assessment at scene: paramedics felt this improved their skillset and confidence. (2) Prealert to hospital: a mixed experience dependent on receiving hospital staff. (3) Handover to hospital team: standardisation of format was viewed as the primary benefit of the PASTA pathway. (4) Assisting in hospital and feedback: due to professional boundaries, paramedics found these aspects harder to achieve, although feedback from the clinical team was valued when available.

Conclusion Paramedics believed that the PASTA pathway enhanced their skills and the emergency care of stroke patients, but a continuing clinical role postadmission was challenging. Future studies should consider whether interdisciplinary training is needed to enable more radical extension of professional boundaries for paramedics.

  • paramedics
  • qualitative research
  • stroke
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Footnotes

  • Handling editor Margaret Samuels-Kalow

  • Twitter @mcclg

  • Contributors GAF, CP and CE designed the PEARS programme of work and secured funding. LS, CP and GAF designed the PASTA trial and prepared the protocol. CP was the trial chief investigator. CE, DF, JL, CP, GAF and LS designed the trial process evaluation. JL, DF and AV conducted interviews. JL, DF, AV and GM analysed data. All authors have commented on interpretation of data and drafts of the manuscript. All authors approved the final manuscript.

  • Funding The work was funded by the National Institute for Health Research (Programme Grants for Applied Research, title: Promoting Effective and Rapid Stroke care (PEARS), project number: RP-PG-1211–20012).

  • Disclaimer The views and opinions expressed here are those of the authors and do not necessarily reflect those of the NIHR or Department of Health and Social Care.

  • Competing interests The employing institutions of all authors received funds from NIHR to enable this work to be undertaken.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting or dissemination plans of this research. Refer to the 'Methods' section for further details.

  • Patient consent for publication Not required.

  • Ethics approval This qualitative study was approved by the National Health Service Research Ethics Committee Newcastle and North Tyneside (Ref 15/NE/0309).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Due to the nature of this qualitative work, data will not be made available.

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