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PP26 Exploring the use of pre-hospital pre-alerts and their impact on patients, ambulance service and emergency department staff: protocol for a mixed methods study
  1. Fiona C Sampson1,
  2. Fiona Bell2,
  3. Peter Webster3,
  4. Joanne Coster1,
  5. Rachael O’Hara1,
  6. Steve Goodacre1,
  7. Alexis Foster1,
  8. Jamie Miles2,
  9. Mark Millins2,
  10. Andrew Pountney2,
  11. Andy Rosser4,
  12. Robert Spaight5,
  13. Janette Turner1,
  14. Aimee Boyd2,
  15. Richard Pilbery2,
  16. Jaqui Long1
  1. 1The University of Sheffield, UK
  2. 2Yorkshire Ambulance Service NHS Trust, UK
  3. 3Public Contributor, affiliated to Leeds Teaching Hospitals NHS Trust, UK
  4. 4West Midlands Ambulance Service University NHS Foundation Trust, UK
  5. 5East Midlands Ambulance Service NHS Trust, UK


Background Ambulance clinicians use pre-alert calls to inform receiving emergency departments (EDs) of the arrival of a critically unwell patient that will require a specialised response. Little is known about how a decision to pre-alert is made and how this is communicated and acted upon in the receiving ED. Whilst appropriate use of pre-alerts benefits patient care, their overuse carries a risk of harm or opportunity costs. The impact of pre-alerts on ambulance clinicians, ED staff and patients is not currently well understood.

Methods We are conducting a mixed methods study with five inter-related work packages. We will analyse 12 months of routine data from ambulance pre-alerts in three regions to identify factors in the variation of pre-alert use, including pre-hospital decision-making. We will undertake a national online Qualtrics survey of ambulance clinician perspectives and experience of pre-alerts. We will explore the impacts of a pre-alert on staff, ED facilities and the patient using semi-structured interviews with ambulance clinicians, ED staff, patients and carers and undertake non-participant observation of ED pre-alert response.

Expected Results We will describe current pre-alert practice using 12 months’ data for 3 Ambulance Services, including volume and types of pre-alerts. We will identify specific conditions or patient groups for whom pre-alerts are most likely to lead to change in clinical practice, or for whom action is unlikely to provide benefit. We will hold a feedback workshop in which we will share and discuss our findings with key stakeholders.

Conclusions Current variation in pre-alert processes, both pre-hospital and in-hospital and the impact on patient care is not understood. The outputs of this study will establish an evidence base to update national guidance for pre-alert practice and identify areas of good pre-alert practice for both ambulance service and Emergency Department staff.

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