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BackgroundPrehospital feedback is increasingly receiving attention from clinicians, managers and researchers. The effectiveness of feedback in changing professional behaviour and improving clinical performance is strongly evidenced across a range of healthcare settings, but this has not yet been replicated within the prehospital context. Without a firmer evidence base, development in practice relies on isolated initiatives with no clear intervention model or evaluative framework. The aim of this study was to understand how UK ambulance services are currently meeting the challenge of providing prehospital feedback.MethodsThis was a national survey, which formed the first part of a realist evaluation of prehospital feedback. The survey used purposive and snowball sampling. It was advertised on social media and sent to prehospital feedback initiative leads identified through grey literature and networking (n=35). In addition n=8 NHS Ambulance Trusts formally supported this study and identified further initiatives (n=17). Data was analysed using content analysis.ResultsWe received responses from n=41 unique prehospital feedback initiatives, equating to a response rate of 79%. Of these n=27 were currently active. Responses were received from within 10 of the 13 NHS Ambulance Trusts in the UK. Initiatives most commonly provided individual patient outcome feedback to individual frontline ambulance staff members using email format, triggered by a request for feedback (i.e. a pull initiative). Common facilitators were engaged and responsive collaborators, with barriers being information governance and the time and resources involved.ConclusionsThis study suggests that the majority of UK Ambulance Trusts currently have examples of prehospital feedback initiatives within their footprint. In contrast with findings from a recent systematic review, there appear to be more initiatives providing individual patient outcome feedback than performance feedback. To further understand how prehospital feedback initiatives work, we will conduct in-depth case studies of 4 initiatives and develop a programme theory as part of our ongoing realist evaluation.

BackgroundEmergency ambulance staff have a strong desire to receive feedback, but the frequency and effects of prehospital feedback have not yet been explored quantitatively in the UK. Surveys on prehospital feedback prevalence have been conducted in the US, but are limited by retrospective data collection and a potential disconnect in recipients recognising that they were being provided with feedback (Cash et al., 2017; McGuire et al., 2021). Our study seeks to overcome these limitations by collecting data in real-time using a diary study design and providing a clear definition of prehospital feedback: ‘the provision of information to emergency ambulance staff regarding their performance within prehospital practice and/or patient outcomes’. The study aim will be to explore the extent, characteristics, mechanisms and effects of prehospital feedback in the UK from the recipients’ point of view and to describe individual differences in the desire for enhanced feedback.MethodsThis will be an observational mixed-methods study involving a baseline survey, diary entries and a follow-up survey. The emphasis of data collection is quantitative survey data, which is supported by qualitative open-ended survey items that will be integrated using triangulation. Data analysis will involve logistic regression (baseline survey), multilevel modelling (diary entries) and content analysis (qualitative data). The baseline survey includes questions on demographics, feedback frequency and the Feedback Environment Scale (Steelman et al., 2004). Participants will be asked to complete 10 diary entries for an event where feedback is received and 5 diary entries where feedback is desired but not received. Eligible participants will be NHS ambulance staff delivering face-to-face patient care. Power calculations suggest a sample size of n=325 participants.Results and ConclusionThe findings from this study will demonstrate how feedback characteristics, person and environment variables influence reported feedback effects in the prehospital setting and highlight missed opportunities for feedback.

BackgroundPrehospital feedback is increasingly receiving attention from clinicians, managers and researchers. The effectiveness of feedback in changing professional behaviour and improving clinical performance is strongly evidenced across a range of healthcare settings, but this has not yet been replicated within the prehospital context. Without a firmer evidence base, development in practice relies on isolated initiatives with no clear intervention model or evaluative framework. The aim of this study is to understand how UK ambulance services are currently meeting the challenge of providing prehospital feedback and generate an explanatory programme theory.MethodsThis mixed methods study will follow a realist evaluation methodology framework with an explanatory case study research design. A realist approach was selected as it will facilitate development of programme theory by exploring context, mechanisms and outcomes. The study will consist of three phases: a pilot case study, a national survey and three in-depth case studies. Phase 1 and 3 of the study will involve semi-structured qualitative interviews and site visits, whilst phase 2 will consist of a cross-sectional survey sent out to leads of UK prehospital feedback initiatives. This study will draw upon a range of existing theories to aid understanding such as the Consolidated Framework for Implementation Research, Normalisation Process Theory and Clinical Performance Feedback Intervention Theory.Results and ConclusionThe three phases of this study will allow for cyclical development, testing and refinement of programme theory by describing existing prehospital feedback intervention types and variations in implementation, as well as evaluating their causal mechanisms and outcomes. Study findings will facilitate an understanding of the extent and limitations of current initiatives, with a view towards identifying opportunities for intervention.

Aims/Objectives/BackgroundThe phenomenon of feedback is well-researched within the wider healthcare context, where it is suggested that feedback can improve patient care and patient safety by enhancing clinical performance and staff mental health. Within prehospital care, reviews have been conducted for automated feedback from defibrillators and debrief after simulation, but not on the wider concept of feedback. The aim of this systematic review is to identify, describe and synthesize the published literature on the types and effects of feedback received by emergency ambulance staff. PROSPERO CRD42020162600.Methods/DesignThe search strategy consisted of three facets: ambulance staff synonyms, feedback synonyms and feedback content. Databases searched from inception were MEDLINE, EMBASE, AMED, PsycInfo, HMIC, CINAHL and Web of Science. Studies were included if they were qualitative or quantitative empirical research exploring the concept of feedback, i.e. the systematised provision of information to emergency ambulance staff regarding their performance within prehospital practice. Study quality was appraised using the Mixed Methods Appraisal Tool and data analysed using narrative synthesis.Results/ConclusionsThe search strategy yielded 2424 articles excluding duplicates. 94 studies met the inclusion criteria after full-text review, of which 36 fleetingly mentioned increased feedback as a solution to improving specific circumstances (e.g. decision-making, burnout). The remaining 58 studies consisted of 48 interventional prehospital feedback studies, 8 non-interventional studies and 2 feasibility studies. Narrative synthesis revealed a wide range of prehospital feedback types with the majority of studies focusing on performance or patient outcome feedback. The effects of feedback encompassed both personal and professional development, such as improved decision-making, reflection and closure. Mechanisms of providing prehospital feedback varied from electronic dashboards to case reviews and performance appraisals. Further empirical research is required to explore whether the published literature reflects current prehospital practice, as well as to determine the when, what, how and why of ambulance staff desiring feedback.

BackgroundInternational studies have shown that the feedback that ambulance staff receive lacks structure, relevance, credibility and routine implementation (Cash, 2017; Morrison, 2017). Research from psychology and implementation science suggests that feedback can change professional behaviour, improve clinical outcomes and positively influence staff mental health (Ivers, 2012; Michie and Williams, 2003). The aim of this study was to explore the experience of ambulance staff regarding current feedback provision and their views on how feedback impacts on patient safety, staff wellbeing and professional development.MethodsA qualitative study conducted as part of a wider study of work-related wellbeing in ambulance staff. 25 semi-structured interviews with prehospital staff in a clinical role from a UK ambulance service sampled using theoretical sampling. Theoretically-informed thematic analysis using psychological theory linked to the self-motives framework for feedback-seeking behaviour.ResultsStudy participants viewed current feedback provision as inadequate and consistently expressed a desire for increased feedback. Participants raised concerns that inadequate feedback could negatively impact on patient safety by preventing learning from mistakes. Enhancing feedback provision was suggested to improve patient safety by supporting professional development and clinical decision-making, through facilitating reflection, knowledge acquisition and professional behaviour change. Similarly, participants thought that enhanced feedback could improve staff wellbeing by enabling closure and encouraging intra-professional dialogue and peer-support. The self-motives framework was useful in interpreting personal and professional motivators for feedback-seeking behaviour within the data.ConclusionsIn accordance with previous research in this area, this study highlights prehospital clinicians’ strong desire for feedback. Furthermore, it suggests that enhancing prehospital feedback could improve patient safety by enriching clinical decision-making and supporting professional development, as well as promote staff wellbeing. Findings from this initial study will be used to guide a PhD programme to address this evidence gap.