RESUMO
Background: Information governance and resource challenges can impede pre-hospital clinicians from accessing and reflecting upon clinical information from the hospital phase of care, to ascertain how appropriate their diagnoses and management were. The authors performed a 12-month service evaluation of a hospital-to-pre-hospital feedback system, in which clinical information was requested by pre-hospital clinicians, and returned by a small team of hospital-based clinicians, while meeting information governance standards. Method: Pre-hospital clinicians in one ambulance station and one air ambulance service accessed patient information from a hospital, via a mediating senior pre-hospital colleague (a facilitator). Case-based learning conversations between the facilitator and clinician followed, using a report from the hospital. Evidence of benefit to the pre-hospital clinicians was prospectively collected using Likert-type scales, regarding general satisfaction, likelihood to change practice and effects on well-being. Reports aimed to be generated by the hospital within 14 days. Results: All 59 appropriate requests had reports returned. Of the reports, 59.5% were returned in 14 days or less. The median duration was 11 days (interquartile range 7-25). Learning conversations were completed in 86.4% (n = 51) of these cases, and of those, clinician questionnaires were completed in 66.7% (n = 34). Of the 34 questionnaire respondents, 82.4% (n = 28) were very satisfied with the returned information. A total of 61.1% (n = 21) were either likely or very likely to change their practice following the hospital's information, and 64.7% (n = 22) reported similar or very similar impressions to the hospital's eventual diagnosis. Regarding mental health, 76.5% (n = 26) reported positively or very positively affected mental health, while 2.9% (n = 1) reported adversely affected mental health. All of the respondents, 100% (n = 34) were either satisfied or very satisfied with the learning conversation. Conclusion: While hospital-based clinical information was successfully and securely provided to pre-hospital clinicians, these pilot data suggest it is not possible to meet the self-imposed, empirical 14-day target with four to five voluntary doctors. Sustained performance may improve with allocated or paid time to report the requests. The validity of these data is limited by a poor response rate, a non-validated questionnaire and potential for selection bias. Validation using multiple hospitals and greater numbers is the appropriate next step. Responses suggest that this system identifies areas for improvement, reinforces good practice and improves the mental well-being of the participating clinicians.
