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PP18 Implementation of electronic patient clinical records in ambulances in the UK: a national survey

Background The roll-out of electronic Patient Clinical Records (ePCR) across UK ambulance services has been an important aspect of modernisation. Electronic Records in Ambulances (ERA) is a two-year study which aims to describe the opportunities and challenges of implementing ePCR and associated technology in emergency ambulances. Our study includes a baseline survey of progress implementing ePCR in all UK ambulance services providing a snapshot of current usage. Methods We carried out semi-structured telephone interviews with information managers in each ambulance service in the UK. We asked them about the systems in use, the process and current stage of implementation and explored the perceived value of using ePCR. If services did not use ePCR we asked about plans for future introduction. The interviews were transcribed and thematically analysed, by three members of the research team. Results We completed interviews with 22 managers from 13 services. Implementation varied across the UK. Seven services were using electronic records. Four services had adopted electronic records but, at the time of interview, had reverted to paper with the intention of implementing a new ePCR. Two services still used paper but hoped to move to ePCR in the future. Those who had fully implemented ePCR reported mixed success in terms of staff compliance, and in realising the potential benefits offered by ePCR to link with primary and secondary care. Reported benefits of ePCR were largely associated with improved data management for audit and record keeping. Potential improvements to patient care were discussed, but tended to be associated with future planned developments. Implications Implementation of ePCR has proved challenging with wide variation in use between ambulance services. Progress has been erratic, rather than linear, demonstrated by difficulties that services experienced putting ePCR into practice. There is potential for ambulance services in the earlier stages of implementation to learn from the experiences of others.

Background Patient outcomes for out-of-hospital-cardiac-arrest (OHCA) should include shorter term response resulting from care delivered by first aiders (CFR) and emergency services as well as any longer term response achieved following handover into hospital care. We construct statistical models of: Return of Spontaneous Circulation while under emergency care (ROSC), and Discharge Alive from hospital (DA). Methods Data on 15,103 OHCA patients aged 4+weeks from East Midlands Ambulance Service NHS Trust were gathered across a 3 year period April 2014 -March 2017. Both outcomes were represented by binary variables (yes=1, no=0). Duration variables: waiting time (WT; time from 999 to emergency service arrival at the patient's side), total treatment time (TOT; time from emergency service arrival to patient handover at hospital), time to ROSC (TtoR; time from emergency service arrival to first ROSC achieved). Statistical analyses were to be conducted on complete records (2825 patients) and involve fitting of a bivariate probit model to the joint outcome (ROSC, DA) and a probit model to the conditional outcome (DA|ROSC=1).

Results
. CFR attendance had no statistically significant influence on either patient outcome. . Patient outcomes worsened as wait time (WT) increased, but was insignificant versus no effect. . Total treatment time (TOT) was significant; with positive influence on ROSC occurrence the longer that time period (estimate >0, p=0.036), but worsening the chance of longer term survival DA (estimate <0, p<0.001). . Time to ROSC (TtoR) was the key driver in the DA| ROSC=1 model (estimate <0, p<0.001), evidencing the better the chances of longer term survival DA the sooner ROSC is achieved.
Conclusions Our Results show that OHCA patient outcomes depend crucially on the quality of clinical care provided by the emergency services. Next steps include the need to gather granular data evidencing the pre-hospital care that is administered to patients by paramedics and community first responders. Background Planning and communication are pivotal in achieving team goals. Studies have shown that teams with effective planning and sharing of mental models display better performance in resuscitation. The Advanced Life Support (ALS) algorithm serves as an overall script regarding specific stages during resuscitation, but it does not explicitly specify how tasks should be delegated or synchronised. Team members therefore need to rely on ongoing, context-specific shared plans for effective team coordination. Methods In our research, we explore paramedic resuscitation teams' verbal communication from a discourse-analytic perspective. We analysed out-of-hospital cardiac arrest (OHCA) resuscitation videos, recorded using body cameras in the field, for plan verbalisation patterns and possible association with successful or unsuccessful outcomes. For the current study, the first five minutes of 10 OHCA resuscitations were transcribed and annotated using a bespoke coding scheme. We focused on how paramedics use language to coordinate their goals and manage the transitions between stages of the OHCA treatment process, and whether this is associated with the deployment of the mechanical compression device, AutoPulse. Results All 10 videos showed similar patterns of plan verbalisation in the first five minutes. The amount of verbalised plans took up nearly half the spoken utterances of all teams, suggesting that paramedics actively shared plans with their team members. Early in the resuscitation, paramedics tended to concentrate on immediate, single-task goals (e.g. moving patient to ideal position) rather than long-term, multi-task goals (e.g. accessing airway). We found little communication of the team leader's overall mental model or script. Instead, plans were shared moment by moment. Based on the 10 videos, the timing of AutoPulse deployment seemed unaffected by the way plans were shared. Conclusion This study enriches our understanding of real-life planning and sharing of mental models during resuscitation. Through these, we can contribute to the betterment of professional interaction in this critical domain. Background The roll-out of electronic Patient Clinical Records (ePCR) across UK ambulance services has been an important aspect of modernisation. Electronic Records in Ambulances (ERA) is a two-year study which aims to describe the opportunities and challenges of implementing ePCR and associated technology in emergency ambulances.

PP18
Our study includes a baseline survey of progress implementing ePCR in all UK ambulance services providing a snapshot of current usage. Methods We carried out semi-structured telephone interviews with information managers in each ambulance service in the UK. We asked them about the systems in use, the process and current stage of implementation and explored the perceived value of using ePCR. If services did not use ePCR we asked about plans for future introduction.
The interviews were transcribed and thematically analysed, by three members of the research team. Results We completed interviews with 22 managers from 13 services. Implementation varied across the UK. Seven services were using electronic records. Four services had adopted electronic records but, at the time of interview, had reverted to paper with the intention of implementing a new ePCR. Two services still used paper but hoped to move to ePCR in the future. Those who had fully implemented ePCR reported mixed success in terms of staff compliance, and in realising the potential benefits offered by ePCR to link with primary and secondary care.
Reported benefits of ePCR were largely associated with improved data management for audit and record keeping. Potential improvements to patient care were discussed, but tended to be associated with future planned developments. Implications Implementation of ePCR has proved challenging with wide variation in use between ambulance services. Progress has been erratic, rather than linear, demonstrated by difficulties that services experienced putting ePCR into practice. There is potential for ambulance services in the earlier stages of implementation to learn from the experiences of others. Background The factors associated with opioid poisoning death are poorly understood. We performed a retrospective autopsy study of decedents of opioid poisoning in Wales in 2015. Using anonymised linked data, we describe demographic characteristics, patterns of emergency service utilisation, and clinical presentation prior to death. Methods Decedents of opioid poisoning in Wales in 2015 were identified from Office of National Statistics (ONS) mortality data. Records were linked with the Emergency Department Dataset (EDDS) by the National Welsh Informatics Service (NWIS); and held in the Secure Anonymised Information Linkage (SAIL) databank. Data were accessed and analysed in the SAIL gateway. Results Age at death ranged from eighteen to seventy-eight years, with a mean of forty-two years. Average male age was forty-one years and average female age was forty-four and a half years. Seventy-six percent of decedents were men (n=98/ 112).
Eight-seven percent of decedents (n=112/129) attended the emergency department in the three years prior to death; eighty-nine in the previous year, ninety-nine in the previous two years and 112 in the previous three years. Eighty-four percent of male and ninety-three percent of female decedents attended the ED in the three years prior to death.
In total 665 attendances were made, half of which involved conveyance by ambulance. Attendances per individual ranged from one to sixty, with over half of decedents attending more than three times. Diagnostic codes were mostly missing or non-specific, with only six and a half percent of attendances representing twenty seven decedents, coded as drug related. Conclusions Matching previously published data, we found that fatal opioid poisoning is preceded by a period of high emergency health service utilisation. On average decedents were in their fifth decade and more likely to be male than female. Attendances varied widely, with men less likely to attend than women. Background Bystander Cardio-Pulmonary Resuscitation (CPR) is a key determinant of survival after Out-of-Hospital Cardiac Arrest (OHCA) but is performed at only around half of OHCA in UK. This study collected data to inform a social marketing strategy to address the barriers to responding to OHCA. Methods A representative sample (n=1027) of Scottish adults aged 16 and over were included in a general population faceto-face omnibus survey in 2015.
Results We identified three factors associated with knowledge, experience, and attitudes toward bystander CPR. Agethe older a person is, the less likely they were to be CPR trained and show willingness to be CPR trained. They were also more likely to have had CPR training more than five years previously and be the least confident to administer bystander CPR. These findings are particularly relevant considering that most OHCA happen in the homes of older people. Social gradepeople in professional managerial and non-manual occupations were more likely than those in manual, unskilled occupations and long-term unemployed people to be CPR trained and be more confident to administer CPR if talked through by a call handler. Working statuspeople who were working were more likely to be CPR trained, be trained more recently and show higher levels of confidence to administer CPR. Barriers cited for not administering CPR were not having the skills or confidence to give CPR, fear of making things worse or of being sued. Conclusions Future social marketing strategies to improve bystander CPR should address the barriers to administering CPR by building confidence and addressing myths/fears. Background Resuscitation of the shocked patient presents a dilemma for the prehospital resuscitation team. Selection of the appropriate type and quantity of resuscitation fluid is not