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Article
Publication date: 27 June 2023

Mike Brady and Edward Harry

Virtual care is any interaction between a patient and clinician or clinicians, occurring remotely using information technologies. Like many international services, United Kingdom…

Abstract

Purpose

Virtual 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/approach

A 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.

Findings

Four main themes were identified with further associated sub-themes: (1) performance, (2) support, (3) distractions and interruptions and (4) confidence in decision-making.

Originality/value

There 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.

Details

International Journal of Emergency Services, vol. 12 no. 3
Type: Research Article
ISSN: 2047-0894

Keywords

Article
Publication date: 27 November 2019

Mike Brady

Telephone triage or hear and treat (H&T) describes the process of UK ambulance services nurses and paramedics undertaking enhanced telephone assessments of patients to determine…

Abstract

Purpose

Telephone triage or hear and treat (H&T) describes the process of UK ambulance services nurses and paramedics undertaking enhanced telephone assessments of patients to determine the most appropriate response, which can sometimes result in no ambulance being sent. Given, however, that 999 is not considered an advice service, it may be reasonable to assert that the expectation of those calling 999 is always an immediate ambulance response. This may not always be realised and may affect patient experience. The purpose of this paper is to ascertain the following: to what extent are the views of UK ambulance telephone triage service users being gathered? In answering this research question, this review also aims to explore the findings to determine service users’ expectations of ambulance telephone triage and the possibility that these expectations are influenced by the UK media. The findings of which could be used to inform the need and nature of future research.

Design/methodology/approach

Phase one consisted of a computerised literature search of online databases CINAHL, Pubmed, Science Direct, Cochrane library, Web of Science and UK government-funded databases. Phase two consisted of searches of all UK ambulance services websites and the submission of freedom of information requests. Phase three consisted of a computerised literature search of the ProQuest international news-stream database.

Findings

A total of 78 results were identified and after further screening 34 results were excluded, leaving 44 for final review. The extent to which users experience of ambulance service telephone triage are being gathered is low; and often limited to one off pieces of non-peer reviewed work. Patients felt overall that they were treated with respect, dignity and care. However, being listened to, reducing anxiety and a need for prompt assurances remain important to those whose overriding expectation is that an ambulance should attend every time a 999 call is made. There appears to be a balanced media portrayal of H&T with the UK media. However, unrealistic public expectations represent a significant barrier to providing sustainable care that users consider to be of high quality.

Research limitations/implications

Some user experiences may have been gathered in more broad research exercises which explored various aspects of 999 ambulance service experience. This was not included if it could not be clearly differentiated as being related to H&T and thus may have resulted in data being omitted. It was not possible to systematically search social media platforms (such as facebook or twitter) for any media results related to this search strategy; only traditional print and online media platforms. This also may have resulted in data being omitted. The inclusion of non-peer reviewed research results and grey literature represents a possible limitation to the conclusions drawn within this review. The concept of Insider Research Bias cannot be ignored within this review. The author himself practices in telephone triage within a UK ambulance service; however, this insider bias is mitigated by the clearly articulated systematic methodology and use of the Critical Appraisal Skills framework. In a similar vein, reviews of this nature are also often conducted as part of a team, to reduce bias, increase objectivity and ensure the validity of findings. This review was a sole effort, and while this is not uncommon, there were no cross checks by peers of the search terms, strategy, paper selection, exclusion criteria or data extraction. This lack of peer critique is considered a possible limitation in mitigating selection and reviewer bias.

Practical implications

The results of this review would suggest a need to increase the amount of research and patient feedback gathered from those being assessed and managed by ambulance service telephone triage within the UK. Ambulance services could hold regular monthly small-scale qualitative interviews with patients and families to ascertain their views, perceptions and anxieties which can then provide an up-to-date understanding of user expectations and the health educational needs of local communities. Patient feedback received directly to ambulance services or via the Patient Advice and Liaison Service could be retrospectively analysed by researchers to determine key themes of positive practice or negative patient experience. Such feedback can be tracked through time and be used as a pre and post community intervention measure, to determine any changes. Moving forward, nationally standardised research frameworks should be adopted to provide more easily collated local and national data, which can monitor improvement strategies and provide a comparison between services to aid the sharing of best practice principles.

Originality/value

There is no other piece of work published which has reviewed the data in this area of clinical practice within the UK.

Details

International Journal of Emergency Services, vol. 9 no. 2
Type: Research Article
ISSN: 2047-0894

Keywords

Article
Publication date: 7 August 2017

Mike Brady

Complaints are an integral element of the quality control and clinical governance process of UK ambulance services, and form a valid and reliable way of identifying areas of…

Abstract

Purpose

Complaints are an integral element of the quality control and clinical governance process of UK ambulance services, and form a valid and reliable way of identifying areas of practice that require improvement. The purpose of this paper is to assess to what extent such complaints and their possible causes are researched; to identify any possible areas of practice requiring further investigation.

Design/methodology/approach

A computerised literature search was conducted using the online databases Science Direct, Cochrane library, and Web of Science, as well as specific searches of the Journal of Paramedic Practice and the International Journal of Paramedic Practice database. Online databases were searched for peer-reviewed full research articles between January 2012 and May 2016.

Findings

A total of 125 papers were identified and after further screening 90 articles were excluded. Additional screening using the critical appraisal skills programme (2014) criterions excluded a further 21 papers, leaving 14 studies for inclusion within the review.

Originality/value

This review found no specific research focussing on any causes of complaints made to UK ambulance services. Moreover, no research was identified specifically investigating the top three cited themes of complaints made in the last three years. More research is required both in researching those themes of complaints already known but also determining any other possible causes of complaints made. This review has evidenced that studies investigating response times improvement strategies, ambulance staff attitudes, and educational assessments of errors, all have findings which are meaningful and valid to determining the possible causes of complaints and possible improvement strategies. Ambulance services, commissioners, practitioners, and clinical academics should endeavour to research and share causes of complaints made to improve the quality of patient care.

Details

International Journal of Emergency Services, vol. 6 no. 2
Type: Research Article
ISSN: 2047-0894

Keywords

Article
Publication date: 1 April 1996

Anna Kochan

Describes the work undertaken by Oxford University’s robotics group, founded in 1985 by Professor Mike Brady. States that these university scientists have their feet firmly on the…

116

Abstract

Describes the work undertaken by Oxford University’s robotics group, founded in 1985 by Professor Mike Brady. States that these university scientists have their feet firmly on the ground and illustrates this by giving details of a number of industrially‐sponsored projects with which they are involved; in the medical, automotive and defence sectors. Shows how the group fits in to Oxford’s engineering department as a whole.

Details

Industrial Robot: An International Journal, vol. 23 no. 2
Type: Research Article
ISSN: 0143-991X

Keywords

Article
Publication date: 1 March 1986

Blending sensor theory and practice, and with a commercial market reckoned to be huge, robotic vision is currently a ‘hot topic’. Here, Professor Mike Brady, explains the advanced…

Abstract

Blending sensor theory and practice, and with a commercial market reckoned to be huge, robotic vision is currently a ‘hot topic’. Here, Professor Mike Brady, explains the advanced research being pursued.

Details

Sensor Review, vol. 6 no. 3
Type: Research Article
ISSN: 0260-2288

Article
Publication date: 1 February 1991

Jack Hollingum

This article is based on a lecture to the Fellowship of Engineering by the head of the Department of Engineering Science, Professor Mike Brady, and an interview with the…

Abstract

This article is based on a lecture to the Fellowship of Engineering by the head of the Department of Engineering Science, Professor Mike Brady, and an interview with the department's specialist on non‐vision sensing and data fusion, Dr Hugh Durrant‐Whyte.

Details

Industrial Robot: An International Journal, vol. 18 no. 2
Type: Research Article
ISSN: 0143-991X

Article
Publication date: 1 October 1997

Jack Hollingum

The Institution of Mechanical Engineers celebrated its 150th anniversary in a symposium on 7‐8 July at the Queen Elizabeth II Conference Centre in London. Its theme was “Visions…

301

Abstract

The Institution of Mechanical Engineers celebrated its 150th anniversary in a symposium on 7‐8 July at the Queen Elizabeth II Conference Centre in London. Its theme was “Visions of the Future ‐ improving the quality of life through technology”, and many senior speakers were invited from industry and academia. Reviews in summary some of the presentations of particular relevance to readers interested in technology.

Details

Industrial Robot: An International Journal, vol. 24 no. 5
Type: Research Article
ISSN: 0143-991X

Keywords

Article
Publication date: 4 February 2014

Kelly O. Cowart, Edward Ramirez and Michael K. Brady

– This research aims to examine the buffering effect of a firm's religious association on customer reactions to a service failure.

1720

Abstract

Purpose

This research aims to examine the buffering effect of a firm's religious association on customer reactions to a service failure.

Design/methodology/approach

Two scenario-driven studies containing religious and non-religious reasons for a store closing were conducted.

Findings

The results from Study 1 suggest that a religious affiliation safeguards against negative reactions to failures related to store policies (see Hoffman et al., 2003). Customers are more likely to forgive transgressing firms when service failures are associated with religion, regardless of attitudes toward the religious group. A follow up study supports the first, even when no specific religion was identified in the scenario, the service failure involved a firm that closed weekly, and a non-student sample was used.

Research limitations/implications

While the results provide support for the buffering effects of a religious affiliation against a particular type of service failure – temporary service interruptions due to the observance of religious holidays and celebrations, future research should test the robustness of this effect on technology failures and rude treatment by employees.

Originality/value

This paper is the first, to the authors' knowledge, to test the effect of a firm's religious affiliation on customer perceptions of frontline service encounters in general and service failures in particular.

Details

Journal of Services Marketing, vol. 28 no. 1
Type: Research Article
ISSN: 0887-6045

Keywords

Content available
Article
Publication date: 1 March 2001

25

Abstract

Details

Kybernetes, vol. 30 no. 2
Type: Research Article
ISSN: 0368-492X

Keywords

Content available

Abstract

Details

Kybernetes, vol. 27 no. 9
Type: Research Article
ISSN: 0368-492X

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