Background Clinical performance feedback has been demonstrated to have positive effects on patient care in hospital and primary care settings (Ivers et al., 2012). Emerging evidence suggests that providing prehospital clinicians with feedback on their performance and patient outcomes may similarly improve patient care, patient safety and staff wellbeing (Wilson et al., 2022). The aim of this study was to describe the predictors and outcomes of feedback received by prehospital clinicians in the UK, and to identify situations where prehospital clinicians desired enhanced feedback.

Methods This was an observational mixed-methods study involving online diary entries between March - August 2022. Eligible participants were emergency ambulance staff delivering face-to-face patient care, employed by NHS ambulance trusts in the UK. Baseline survey data was analysed using logistic regression and diary entries were analysed using multilevel modelling and content analysis. Feedback effects were categorised using hierarchical cluster analysis.

Results The baseline survey was completed by n=299 participants, a third of which (n=101) went on to submit n=956 diary entries. Patient outcome feedback was the most frequently received feedback type (n=226). Significant predictors for receiving feedback were paramedic role (p=0.024), workplace with good feedback-seeking culture (p=0.001) and white ethnicity (p=0.024). Categories of feedback effects were personal development (closure, confidence, job satisfaction), professional development (clinical practice, knowledge) and service outcomes (patient care, patient safety). Feedback on patient satisfaction was associated with positive effects on service outcomes (p=0.017), whilst patient outcome feedback was associated with positive effects on professional development (p=0.056). Feedback was most frequently desired for non-conveyed patients and those with neurological or cardiovascular conditions.

Conclusion Feedback and follow-up to prehospital clinicians improves personal development, professional development and service outcomes. The results of this study highlight subsets of patients and staff that prehospital feedback should be enhanced for to improve clinical decision-making and staff wellbeing.