Abstract
Background: The role of ambulance services is shifting, partly due to the volume of relatively well patients who do not require direct conveyance to the emergency department (ED). Specialist paramedics, known as extended care paramedics (ECPs), are increasingly being employed in New Zealand and internationally to manage part of the Emergency Ambulance Services’ (EAS) primary care workload.
Akin to other generalist clinicians, ECPs clinical assessment skills have become honed over time. This is largely out of necessity; ECPs assess high-needs patients in the community with only a limited range of diagnostics at their disposal. However, making a clinical diagnosis has its limitations; it can be difficult to establish an accurate physiologic baseline using vital signs and physical exam techniques alone.
Point-of-care blood testing (POCbT) reduces laboratory results turnaround time, which has afforded many advantages in hospital departments. However, the gains related to initiating POCbT in the prehospital setting are largely unknown. Among its theorised benefits, POCbT has the potential to improve clinical decision-making and reduce non-essential ED presentations when used in ambulatory care settings.
Aim: To evaluate whether POCbT supports the diagnosis and management of patients seen by extended care paramedics. The perceived clinical impact will be investigated with particular focus on clinical decision-making. Insights gained about the ECP use of POCbT will be disseminated so that any findings may be of use for other services considering implementing POCbT.
Methodology: Qualitative research using semi-structured interviews and focus group discussions with ECPs. This study centres on a recent trial conducted by Wellington Free Ambulance (WFA) where ECPs integrated POCbT into their normal practice for a period of 5 months.
Analysis: Focus group discussions and interviews were transcribed verbatim and analysed inductively using Braun and Clark’s Reflexive Thematic Analysis framework.
Findings: While the clinicians using the devices found that POCbT had a positive impact on their clinical practice, there were also several barriers to use that resulted in a relatively low utilisation rate. These findings support a similar trend reported in primary care literature. Key clinical applications of POCbT experienced by the ECPs were to help guide the appropriate referral pathway, to rule out serious differential diagnoses, and to support the management of patients with an unclear diagnosis.
Conclusions: The full potential of POCbT use by ECPs is not yet fully understood. Before this can be realised, the barriers that prevent clinicians from using it need to be addressed. A longer trial is required to clearly define the clinical impact POCbT has in community paramedicine to increase confidence in this technology, both from the perspective of the clinician and policy makers.