SERVICE USER PERSPECTIVES ON PATIENT SAFETY IN THE AMBULANCE SERVICE (Emergency Medicine Journal)

Background The contribution of service users to identifying and prioritising research issues is vital to make practice and policy more relevant to their needs. Their experiences and knowledge can complement those of clinicians, health professionals and researchers. The aim of this research was to explore service-user perceptions of ambulance service care and patient safety. Methods Three service-users focus groups (n=23) were conducted in three different Ambulance Service Trust regions and enabled participants to discuss their respective perceptions, experiences and concerns. Discussions were audio-recorded, transcribed and thematically analysed. Findings Service-users identified a number of concerns. The skills of call handlers in managing two-way communication at the initial call stage was perceived as critical to informing appropriate triage decisions; the risk at this stage was considered to be higher where callers have communication difficulties. Participants emphasised the importance of patient involvement in decisions made at-scene, and carers/advocates where appropriate; however, different levels of understanding in relation to their rights were apparent. Awareness of new ambulance service roles and alternatives to ED conveyance also varied. Non-conveyance was viewed as an acceptable option and even preferable where appropriate, and where alternative care options are assured. Participants were aware of the demands facing front-line staff and the impact of 24/7 accessibility, while other services were perceived as more difficult to access, in part due to limited awareness. Risk aversion amongst the public and health professionals was also perceived as a potential contributor to the increased demand for emergency care. Conclusions Despite the relatively small number of participants, the findings provide useful service-user perspectives relevant to pre-hospital emergency care policy and practice, as well as the wider urgent and emergency care context. It is important that such views can be represented through public/patient involvement in decision making at organisational and service commissioning level.