A new study focusing on decision making by paramedic and specialist paramedic staff and conducted in three English National Health Service (NHS) Ambulance Service Trusts was published this month. The study, entitled ‘A qualitative study of systemic influences on paramedic decision making: care transitions and patient safety‘ published in the Journal of Health Services Research and Policy was led by Dr Rachel O’Hara from ScHARR at the University of Sheffield and included Professor Niro Siriwardena, director of CaHRU, and Debbie Shaw, visiting fellow at CaHRU, and both members of the East Midlands Ambulance Research Alliance at East Midlands Ambulance Service NHS Trust.

The study involved observation and interviews, analysis of digital diaries and focus groups with paramedic staff. Different types of decision were identified, ranging from the decision to convey a patient to the emergency department, use of specialist emergency pathways or the decision to treat and leave a patient at home. Systemic influences and risk factors affecting decision making included demand, performance priorities, access to care options, risk tolerance, training, communication, feedback and resources.

The study highlighted the complexity of paramedic decision making and system factors which could worsen risk. Decision making has been studied in other settings but rarely in the prehospital environment, and the uncertainty which paramedics have to face when making decisions needs further work. The study forms part of the Prehospital Emergencies Quality and Outcomes programme at CaHRU.