Increasingly, ambulance services have a role to play in keeping people out of hospital. Instead of transporting people to the emergency department, they might provide them with care in their own home, or refer them to a community-based provider such as a falls service. For this to happen safely and effectively, paramedics need to be able to make the right decision for patients, for which they need the right information; they need to be able easily and accurately to pass on the patient's details; and they need to make a record of their contact with their patient.
Technology can have a role in helping paramedics with all of these, and so help to keep people out of hospital. Electronic records are not just useful in their own right, but can be linked to other technology which helps paramedics to make the correct decision and put people in touch with services to help them. Some ambulance services are recording patient information electronically, but some are not. We know that switching to new technology is not always straightforward and it can make a change to people's jobs - sometimes in ways which aren't expected.
This research aims to find out how ambulance services can make the best use of information technology to support people with good quality care out of hospital. We will look at what happens day to day, when paramedics use technology in practice; at how the ambulance service as an organisation starts to use new technology and adapts to the changing landscape of care; and at what happens in between, as paramedics respond to this changing environment, learn new skills and change their role and practice. We will talk to all the ambulance services in the UK to find out what they are doing in terms of introducing electronic records and other IT to support care delivery and decision making. We will then do a detailed study of four ambulance services - one service which has used electronic records for a few years, one which does not use them, and two which are part way through bringing them into use. In each area we will have a research paramedic who will find out about how decisions are made about using electronic records and technology, whether and how they are used, what people feel about them, and what difference they have made (or could make) to how paramedics and the service work. We will analyse data about current levels and patterns of usage of electronic records.
We will talk to paramedics, managers, and people running other relevant health services, read reports and documents and spend time on ambulances looking at how records and other technology are used. We will compare what has gone on across the four sites. We will look in detail at care for people with three particular conditions (falls, diabetic hypoglycaemia, mental health crisis) which have potential for increased non-conveyance, to see what difference electronic records in ambulances are making - or could make - to people with those conditions. We will then bring together all the ambulance services in the UK to talk about what we have found and discuss what they think will be the best way to make use of technology to help paramedics keep people out of hospital.
This project, funded by NIHR HS&DR programme, is being led from Swansea University: http://www.primecentre.wales/era.php.
HSRU is supporting data collection and analysis across Scotland.
Data Collection - Ongoing