A qualitative study on conveyance decision-making during emergency call outs to people with dementia: the HOMEWARD project
Dublin Core
Title
A qualitative study on conveyance decision-making during emergency call outs to people with dementia: the HOMEWARD project
Subject
Prehospital care, Emergency ambulance systems, Dementia, Geriatrics, Admission avoidance
Description
Background
Paramedics are increasingly required to make complex decisions as to whether they should convey a patient to
hospital or manage their condition at the scene. Dementia can be a significant barrier to the assessment process.
However, to our knowledge no research has specifically examined the process of decision-making by
paramedics in relation to people with dementia. This qualitative study was designed to investigate the factors
influencing the decision-making process during Emergency Medical Services (EMS) calls to older people with
dementia who did not require immediate clinical treatment.
Methods
This qualitative study used a combination of observation, interview and document analysis to investigate the
factors influencing the decision-making process during EMS calls to older people with dementia. A researcher
worked alongside paramedics in the capacity of observer and recruited eligible patients to participate in case
studies. Data were collected from observation notes of decision-making during the incident, patient care records
and post incident interviews with participants, and analysed thematically.
Findings
Four main themes emerged from the data concerning the way that paramedics make conveyance decisions
when called to people with dementia: 1) Physical condition; the key factor influencing paramedics' decisionmaking was the physical condition of the patient. 2) Cognitive capacity; most of the participants preferred not to
remove patients with a diagnosis of dementia from surroundings familiar to them, unless they deemed it
absolutely essential. 3) Patient circumstances; this included the patient's medical history and the support
available to them. 4) Professional influences; participants also drew on other perspectives, such as advice from
colleagues or information from the patient's General Practitioner, to inform their decision-making.
Conclusion
The preference for avoiding unnecessary conveyance for patients with dementia, combined with difficulties in
obtaining an accurate patient medical history and assessment, mean that decision-making can be particularly
problematic for paramedics. Further research is needed to find reliable ways of assessing patients and accessing
information to support conveyance decisions for EMS calls to people with dementia.
Paramedics are increasingly required to make complex decisions as to whether they should convey a patient to
hospital or manage their condition at the scene. Dementia can be a significant barrier to the assessment process.
However, to our knowledge no research has specifically examined the process of decision-making by
paramedics in relation to people with dementia. This qualitative study was designed to investigate the factors
influencing the decision-making process during Emergency Medical Services (EMS) calls to older people with
dementia who did not require immediate clinical treatment.
Methods
This qualitative study used a combination of observation, interview and document analysis to investigate the
factors influencing the decision-making process during EMS calls to older people with dementia. A researcher
worked alongside paramedics in the capacity of observer and recruited eligible patients to participate in case
studies. Data were collected from observation notes of decision-making during the incident, patient care records
and post incident interviews with participants, and analysed thematically.
Findings
Four main themes emerged from the data concerning the way that paramedics make conveyance decisions
when called to people with dementia: 1) Physical condition; the key factor influencing paramedics' decisionmaking was the physical condition of the patient. 2) Cognitive capacity; most of the participants preferred not to
remove patients with a diagnosis of dementia from surroundings familiar to them, unless they deemed it
absolutely essential. 3) Patient circumstances; this included the patient's medical history and the support
available to them. 4) Professional influences; participants also drew on other perspectives, such as advice from
colleagues or information from the patient's General Practitioner, to inform their decision-making.
Conclusion
The preference for avoiding unnecessary conveyance for patients with dementia, combined with difficulties in
obtaining an accurate patient medical history and assessment, mean that decision-making can be particularly
problematic for paramedics. Further research is needed to find reliable ways of assessing patients and accessing
information to support conveyance decisions for EMS calls to people with dementia.
Creator
Sarah Voss, Janet Brandling, Katherine Pollard, Hazel Taylor, Sarah Black and Marina Buswell
Source
: http://dx.doi.org/10.1186/s12873-020-0306-6
Publisher
BioMed Central Ltd.
Date
Jan. 29, 2020
Contributor
Fajar Bagus W
Format
PDF
Language
Indonesia
Type
Text
Files
Collection
Citation
Sarah Voss, Janet Brandling, Katherine Pollard, Hazel Taylor, Sarah Black and Marina Buswell, “A qualitative study on conveyance decision-making during emergency call outs to people with dementia: the HOMEWARD project,” Repository Horizon University Indonesia, accessed November 21, 2024, https://repository.horizon.ac.id/items/show/3533.