Perceived benefits and limitations of remote decision-making support for ambulance clinicians in a single NHS trust.

Introduction: Remote decision-making support (RDMS) systems for on-scene ambulance clinicians aim to improve patient safety, avoid unnecessary admissions and promote appropriate referrals. In the relative absence of previous research, this qualitative study explored the perceived benefits and limitations of a well-established RDMS system in a single NHS ambulance trust. The system described involves advanced paramedic practitioners (APPs) supporting colleagues via an emergency-crew advice telephone line (ECAL). Methods: Internally circulated invitations resulted in a convenience sample of 27 participants attending online meetings for data collection. Eight meetings, with a mean duration of 56 minutes, were recorded and anonymised during transcription. A critical realist, experiential approach to thematic analysis was employed on transcripts to produce findings. Results: Participants reported various patterns of engagement with ECALs, but experienced paramedics were the least involved. ECALs were perceived to benefit patient safety and clinical development, although their influence on appropriate care delivery was considered to be more limited. The information systems, capacity and capability of community care pathways varied considerably across the region, hindering urgent care navigation. Additionally, a cultural shift to normalise collaborative decision making was required, which might be enabled by more proactive intervention, but only if ECAL interactions sustained trust in their effectiveness. Some participants had experience of initiatives where co-located community and emergency department clinicians augmented RDMS provision and perceived that this addressed many of the limitations identified. Conclusion: This study suggests that RDMS is perceived as beneficial to patient safety and appropriate care delivery, and that APPs who are familiar with their region and with the clinicians on scene are well suited to provide this support. Collaborative decision making requires honest and open interaction to be effective and needs to be more widely accepted as standard clinical practice. Improving the consistency and interoperability of community care pathways will maximise their value, and inter-professional collaboration may facilitate this.