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3.2 Estadística Inferencial Hipótesis general:
When the ambulance crew travel to the scene, they can only view the incident initial information that has been provided by the call handler via the MDT. However, the information inserted by the call handler, is as received by the call maker who is describing the incident from their point of view, which might not always represent the actual situation. Therefore, when the ambulance crew reach the scene, they might find a different situation to the one that has been reported. Being in an emergency incident, the crew will act according to the situation, as urgent responses are essential. All of these actions related to the patient will later be recorded in the ePRF, once the condition of the patient is stabilized.
This delayed act of recording information in the ePRF may cause problems (Pirnejad et al., 2008), as an ambulance crew may forget to report some informa-tion to ED staff during handover. That is why some crews will jot down essential information on their gloves or on a piece of paper. After the patient is transferred to the care of ED, a member of crew will insert the incident information into the ePRF to record it. This delayed action of completing the ePRF later in the process prevents the ED staff accessing the finalized ePRF instantly if needed. This leaves them with no choice but to rely heavily on the ambulance crew verbal handover or upon information from the patient directly if their health permits. This is not
always a smooth and problem free process (Manser and Foster, 2011). See Section 9.2.
As mentioned previously, feedback to NEAS front-line operational roles by man-agement is essential. Equal importance is also laid on the inter-organisation feed-back to NEAS front-line operational roles, for example, feedfeed-back to crew by ED staff. Feedback to the ambulance crew can improve their performance (Levick and Swanson, 2005; Kramer-Johansen et al., 2006), the quality of pre-hospital care to patients on scene (Lyon et al.,2012), and increase paramedics confidence (Thakore and Morrison, 2001). Mock et al. (1997) have noted the importance of providing feedback from ED staff and patients to ambulance services. The authors have dis-cussed whether formal regular and constructive feedback channels should be open between ED and ambulance services. As feedback provides both a learning process and also a sense of satisfaction to the ambulance crew. Delayed feedback is better than none, as feedback provides information to ambulance services that can aid the provision of care by applying constructive changes to the system for the benefit of all. Gränsevik(2015) also supports the idea of the importance of feedback to ambu-lance services and emphasises that the lack of feedback to ambuambu-lance service staff could have negative psychological effects on crews. In contrast, the availability of feedback can have positive effects on quality improvements, individual development and increased knowledge within the ambulance service. NEAS ambulance crews do not receive any feedback from external organizations on their work performance.
Each organization has different priorities and agendas and this leads working processes to be interdependent on the intra-organizational level, but independent on the inter-organizational level. Establishing regular meetings between NEAS and the trusts they serve (JCUH ED) is essential to open those communication channels between organizations. This can be achieved by setting shared goals, providing financial support for joint projects to increase ownership, incentives, involving front-line end-users to maximise benefits, etc.
NEAS did not consult JCUH or ED staff when designing or implementing the ePRF system. Once the system was rolled out, authorized ED staff were informed
of it and trained on how to access the online ePRF. Although the ePRF is available to specific ED staff 24/7, it is only accessed on limited occasions. ED staff reported that they prefer to spend time providing care for emergency patients rather than accessing the online form that consumes their time. Although NEAS has provided this system to support the inter-organizational communication aspect, ED staff do not appear to be utilizing it, for reasons mentioned earlier.
Similarly, this problem in the ED of JCUH happened again with another system NEAS installed in the ED. Those are the Docking Stations and the patients arrival alerting screens. Docking Stations, in addition to alerting screens, were installed in every ED that NEAS serves. They do not provide any benefit to the ED staff or their work process. Docking Stations are for the sole use of the ambulance crew.
The alerting screens installed in the nurse station, receive update information of the incident initial information. Even when the alerting screen displays live information with the job category, it appears that ED staff seldom pay attention to it for various reasons. For example, ED staff cannot make any preparation based on incident initial information that may not be clinically accurate, simply because this information is from the call maker’s perspective and so may not present the actual clinical situation.
This “technology-push” (Greenhalgh et al.,2008) to ED staff has created a sense of a lack of ownership and has some resistance to its use. Again, not involving ED staff on the development of the system has created this gap. Unfortunately, all of this technology NEAS is providing and the resources spent is not enhancing this aspect of inter-organizational communications.
5.4 Summary
This chapter, with the following Chapter6, represent the first phenomenological study. Providing background information and a description about NEAS Founda-tion Trust in the wider health context, followed by the communicaFounda-tion procedures applied by NEAS control centre with ambulance crews. This includes the dispatch mechanism of crews, communication interactions occurrence between control centre
and crews, and the patient handover to ED staff if a patient is conveyed to the ED. This was helpful in identifying the intra-organizational communications gaps within NEAS with reference to the ambulance crews. These were the lack of reliable information, connectivity and feedback. The nature of the ambulance crew working process was an added challenge to the communication process, as the ambulance crew work a 24/7 on demand service, always mobile and geographically scattered.
This communication gap in NEAS is not on the front-line crew operational level only, but it also extends to the management level. NEAS management does not uti-lize the vast information they already hold in their PRF/ePRF databases with crews . For example, they do not inform the crew of multiple same day dispatches to the same patient. NEAS did not even involve the ambulance crews in the development and implementation process before the ePRF system was live.
The gap is not only on the intra-organizational communication level, but it also occurs on the inter-organizational level. The ambulance crew while on scene, do not have any access to any external database for the patient to support them in their decision-making. Additionally, the ePRF systems lack a seamless mechanism to record on scene patient information. This lack of support caused out-of-system workarounds to be applied, causing delays in accessing the finalized ePRF by ED staff. Ambulance crews not only lack feedback from NEAS management, but they also lack feedback on their performance from external organizations like the ED.
Further, NEAS should collaborate more with other ambulance trusts, hospitals, and other health and non-health providers when introducing new HIT to set goals, share aims, identify incentives, and facilitate communication channels. Collectively, this helped to shape background information of the other non-technical (sociotechnical) aspects that may surround the development of the IB.