What effects did home working have on 999 clinician practice from one UK ambulance service during the Covid-19 pandemic?

Abstract

PurposeVirtual care is any interaction between a patient and clinician or clinicians, occurring remotely using information technologies. Like many international services, United Kingdom (UK) ambulance services use paramedics and nurses to undertake telephone assessments of patients calling the 999 emergency service line. Using their clinical knowledge, experience, and, at times, computer decision support software, these clinicians assess patients from a range of clinical acuities to confirm the need for an emergency response or identify and support those patients who can be cared for with remote treatment advice and referral. The Covid-19 pandemic saw UK ambulance services change and adapt their operating models to meet social distancing requirements, increase clinical staff numbers and mitigate staff becoming unavailable for work due to self-isolation. One such strategy was moving clinicians from Emergency Operations Centres (EOCs) to working at home. Staff utilised digital phone systems, remote computer-aided dispatch modules, remote clinical decision support software and video platforms, which allowed close to full functionality compared to inside typical EOCs. There is a dearth of literature exploring the comparative practice of clinicians from home rather than from EOCs. Therefore, this study reports the findings of a qualitative analysis of these effects from the clinician's perspective. The authors hope that the findings from this study will inform the operating, education and leadership practices of those delivering such services.Design/methodology/approachA convenience sample of telephone nurses and paramedics from one UK ambulance service in which home working had been implemented were contacted. 15 clinicians with recent home working experience responded to the invite out of a possible 31 (48%). All participants had previously practised remote assessment from within an EOC. Semi-structured interviews took place via video conferencing software and were recorded, transcribed and thematically analysed. An inductive approach was taken to generating codes and both researchers separately reading the transcripts before re-reading them, assigning initial themes and determining frequency.FindingsFour main themes were identified with further associated sub-themes: (1) performance, (2) support, (3) distractions and interruptions and (4) confidence in decision-making.Originality/valueThere are very few studies exploring the practice of remote clinicians in emergency EOCs. This study identified that home working clinicians felt their productivity had increased, making them more satisfied in their practice. However, there were mixed feelings over the level of support they perceived they now received, despite the mechanisms of support being largely the same. Supervisors found it especially challenging to provide support to practitioners; and employers might need to clarify the support mechanisms they provide to homeworkers. The elimination of distractions and interruptions was seen as a largely positive result of homeworking; however, these interruptions were not seen as inappropriate, thus, identifying a need for role clarity and task coordination rather than interruption elimination. Finally, clinicians felt that they become more confident when working from home, researching more, trusting themselves more and relying less on others to reach safe outcomes. However, there were missed opportunities to learn from listening to others' clinical practice.