How consistent are pre-alert guidelines? A review of UK ambulance service guidelines.

Autor:	Boyd A; South East Coast Ambulance Service NHS Foundation Trust ORCID iD: https://orcid.org/0000-0003-1030-8167., Sampson FC; University of Sheffield ORCID iD: https://orcid.org/0000-0003-2321-0302., Bell F; Yorkshire Ambulance Service NHS Trust ORCID iD: https://orcid.org/0000-0003-4503-1903., Spaight R; East Midlands Ambulance Service NHS Trust ORCID iD: https://orcid.org/0000-0003-4361-5876., Rosser A; West Midlands Ambulance Service University NHS Foundation Trust ORCID iD: https://orcid.org/0000-0002-5477-4269., Coster J; University of Sheffield ORCID iD: https://orcid.org/0000-0002-0599-4222., Millins M; Yorkshire Ambulance Service NHS Trust., Pilbery R; Yorkshire Ambulance Service NHS Trust ORCID iD: https://orcid.org/0000-0002-5797-9788.
Jazyk:	angličtina
Zdroj:	British paramedic journal [Br Paramed J] 2024 Mar 01; Vol. 8 (4), pp. 30-37.
DOI:	10.29045/14784726.2024.3.8.4.30
Abstrakt:	Aims: Ambulance pre-alerts are used to inform receiving emergency departments (EDs) of the arrival of critically unwell or rapidly deteriorating patients who need time-critical assessment or treatment immediately upon arrival. Inappropriate use of pre-alerts can lead to EDs diverting resources from other critically ill patients. However, there is limited guidance about how pre-alerts should be undertaken, delivered or communicated. We aimed to map existing pre-alert guidance from UK NHS ambulance services to explore consistency and accessibility of existing guidance. Methods: We contacted all UK ambulance services to request documentation containing guidance about pre-alerts. We reviewed and mapped all guidance to understand which conditions were recommended for a pre-alert and alignment with Association of Ambulance Chief Executives (AACE) and Royal College of Emergency Medicine (RCEM) pre-alert guidance. We reviewed the language and accessibility of guidance using the AGREE II tool. Results: We received responses from 15/19 UK ambulance services and 10 stated that they had specific pre-alert guidance. We identified noticeable variations in conditions declared suitable for pre-alerts in each service, with a lack of consistency within each ambulance service's own guidance, and a lack of alignment with the AACE/RCEM pre-alert guidance. Services listed between four and 45 different conditions suitable for pre-alert. There were differences in physiological thresholds and terminology, even for conditions with established care pathways (e.g. hyperacute stroke, ST segment elevation myocardial infarction). Pre-alert criteria were typically listed in several short sections in lengthy handover procedure policy documents. Documents appraised were of poor quality with low scores below 35% for applicability and overall. Implications: There is a clear need for ambulance services to have both policies and tools that complement each other and incorporate the same list of pre-alertable conditions. Clinicians need a single, easily accessible document to refer to in a time-critical situation to reduce the risk of making an incorrect pre-alert decision. Competing Interests: RP is the previous editor-in-chief of the BPJ (2016–2022). (© 2024 The Author(s).)
Databáze:	MEDLINE
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