Sarah Black
Doctorate
Doctorate Title: Factors influencing pre-hospital decisions not to convey: a mixed methods study.
Doctorate Description: This study used a multi-phase mixed design, consisting of four distinct work packages allowing for the collection of data in both sequential and concurrent timings within one series of studies. In this design both the qualitative and quantitative components have equal priority, recognising the pragmatist stance that both will play an important role in answering the research questions.
This study explored the impact of geographic, temporal and ambulance crew skill factors on ambulance clinicians’ decisions to leave a patient on scene after attending a 999 call. Four phases of work were undertaken using both qualitative and quantitative methods to build an understanding of the complex nature of pre-hospital clinical reasoning.
A novel scale, the DMASC survey, was developed, which indicated four factors influence decision-making in this context. More experienced staff scored significantly differently to other staff groups on the ‘Experience’ and ‘Patient characteristic’ sub-scales of the tool.
Qualitative work explored these findings in more detail and five inter-related themes were identified, namely, ‘Communication’, ‘The three ‘E’s’, education, experience and exposure’, ‘System influences’, ‘Professionalism’ and ‘Patient characteristics’.
The third phase of the study undertook to analyse retrospective call data from one large UK ambulance service over a one-year period. All of the five predictor variables, rurality, time of day, day of the week, patient condition and crew skill level, influenced the likelihood of conveyance. Of these the level of clinical skill of the first crew at scene was independently significant.
The results of this work are integrated in the final work package and discussed in relation to the strategic and operational context of NHS ambulance services.
Details:
Type: Professional Doctorate
University: University of Exeter
Primary Supervisor: Dr Ian Frampton
Category: Other
Funding:
Start Date: 2011
End Date: 2017
Status: Complete
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