Table 6

Factors reported by crews to encourage or hinder transportation to MIU with quotes

FactorFrequency of reportingExample: quote
Hindering conveyance
Distance11“This particular case, we didn’t take him to W because he lived in F, so way out of the way to take him all the way to W for just a cut on the back of the hand.”
Study issues:
• restrictive protocols11“The only problem that we’ve said all along is what we can take [to MIU]. We’re quite restricted.”
• study design8
• lack of training in protocol use3“It has been a bit confusing I must admit. I know some people have got confused with which is which. But it is very difficult to do this control and intervention week. I understand why it was needed for the study but at the end of the day the patient is more important and what happens to them. I feel that even though it may not be the right week if they need to go then it’s best for the patient.”
Facilities at MIU11“I know from experience at W that they can overview X-rays, whereas at H I believe they can’t, they’re relying on a GP to look at the X-rays. That’s not running them down it’s just a statement of fact.”
MIU staff support11“But even when we felt it could possibly go to [MIU] there was the aspect of the staff there. I didn’t feel they were supporting the project. They are nice people but I felt it was seen as extra work for them and I think it was hassle sorting out getting [patients] home.”
Time issues“Opening times, well there is a variation but if [the MIUs were] open for longer it increases the chances of us taking patients there clearly, but they must be regular hours each week.”
• opening times of the MIUs10
• increased downtime (the ambulance busy on a call) if a patient was not accepted by the MIU3
• increased time to make decisions about the destination of a patient1
Patient characteristics, for example, age/underlying medical condition9“This first one, this gentleman here, was picked up at a place for dementia patients. They wouldn’t have been able to cope with the condition of dementia [at MIU].”
Patient choice?“The second [patient] definitely could have gone [to MIU] but through her own choice she wanted to go to [A&E] because it’s nearer to home and she was being picked up by her son, therefore it was easier for her to go to [A&E]. It’s only a couple of miles to her home.”
Ambulance service issues such as communication6“So for instance we came in late on Tuesday to start work, we’d gone out on the road thinking shall we, shan’t we. And we asked Control are we on a control week or are we on an intervention week, and they can’t tell us because they claim they don’t have the information.”
Low numbers of appropriate cases4“Well one of the reasons why we didn’t go there, we just never presented with anything appropriate on the protocols to go. It’s as simple as that.”
Litigation fears3“The trouble is that in some respects you know there’s always the thought in the back of crews minds about litigation. If you take them to [MIU] and they should have gone to the main hospital will these people sue us for taking them to the wrong hospital you know, and you’ve always got that in the back of your mind.”
Encouraging conveyance to MIU
Distance to MIU15“Basically with the MIU, normally we decide to go there if it meets criteria, its minor injuries, and if it’s normally within W and nearer to the MIU.”
Reduced waiting time in MIU14“The bottom line for patients is that they know they’re going to end up waiting 4 to 6 hours in A&E on a number of occasions, so if you can offer them an alternative most of them I’m sure will take the bait.”
Valued resource8“Basically I think [the MIUs] are a good idea. Whether or not after this year, you know I imagine everything will still be in place, but whether the protocols will change or whatever, but I think we should use it more and I think we will do.”
Clear meeting of protocols7“Oh yes, I’d give [the MIU] a try. I mean somebody with just a wound on the back of the hand that probably needed some steristrips or a person that’s just got a small cut on her head and there’s not any underlying problem then I would go to the MIU first.”
Patient preference5“That one there, the lady insisted on going to W [MIU] purely because her husband died at St Peters so she didn’t want to go there as an emergency...She was delighted that she could go there, absolutely delighted.”
Crew characteristics3“Length of service. To be honest with you I think that being a younger crew, which we are, we are a bit more flexible. The older members they’ve only known this is how we do it and that’s it.”
Reduced time to handover at MIU3“[The MIU] does us a lot because our turn around time is a lot better, and being in W you’re literally minutes away from the hospital, so yes I think it’s a good idea.”