Prioritizing novel and existing ambulance performance measures through expert and lay consensus: A three-stage multimethod consensus study.

BACKGROUND: Current ambulance quality and performance measures, such as response times, do not reflect the wider scope of care that services now provide. Using a three-stage consensus process, we aimed to identify new ways of measuring ambulance service quality and performance that represent service provider and public perspectives. DESIGN: A multistakeholder consensus event, modified Delphi study, and patient and public consensus workshop. SETTING AND PARTICIPANTS: Representatives from ambulance services, patient and public involvement (PPI) groups, emergency care clinical academics, commissioners and policymakers. RESULTS: Nine measures/principles were highly prioritized by >75% of consensus event participants, including measures relating to pain, patient experience, accuracy of dispatch decisions and patient safety. Twenty experts participated in two Delphi rounds to further refine and prioritize measures; 20 measures in three domains scored ≥8/9, indicating good consensus, including proportion of calls correctly prioritized, time to definitive care and measures related to pain. Eighteen patient/public representatives attended a consensus workshop, and six measures were identified as important. These include time to definitive care, response time, reduction in pain scores, calls correctly prioritized to appropriate levels of response and survival to hospital discharge for treatable emergency conditions. CONCLUSIONS: Using consensus methods, we identified a shortlist of ambulance outcome and performance measures that are important to ambulance clinicians and service providers, service users, commissioners, and clinical academics, reflecting current pre-hospital ambulance care and services. The measures can potentially be used to assess pre-hospital quality or performance over time, with most calculated using routinely available data.

How do patients feel about taking part in clinical trials in emergency care?

BACKGROUND: There is little in-depth research into how patients feel about emergency medical trials, and what influences these feelings. OBJECTIVES: To investigate patients' feelings on taking part in emergency medical research, particularly trials conducted without prospective consent. METHODS: Seventeen inpatients, all recently admitted with a medical emergency, were interviewed. Questions focused on feelings on taking part in hypothetical trials, particularly trials conducted with deferred consent. RESULTS: Five main themes were identified. Level of trust in the medical profession-high levels of trust tended to correlate with willingness to participate in trials. Previous bad healthcare experiences tended to diminish trust. Concerns for personal well-being-patients identified a conflict between aversion to unknown side effects and desire for access to newer and potentially better treatments. Some would be less inclined to participate in research if they were severely unwell, some more so. Altruism-many cited the importance of helping to advance medical knowledge and of 'giving back to the health service'. Concerns over autonomy-some felt that deferred consent was a violation of personal autonomy. Uncertainty-many patients seemed to struggle to understand the more complex concepts discussed. CONCLUSIONS: Patients are broadly trusting, and open to participating in emergency medical trials, but want to be kept as informed as possible throughout the process. Willingness may be improved by providing more complete explanations, although this may be limited by the complexity of relevant concepts. Good communication and improved public understanding of clinical trials would likely increase acceptance of emergency care research.