PP34 Prehospital feedback & follow-up: a review of current practice in the United Kingdom

Background Prehospital 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. Methods This 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. Results We 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. Conclusions This 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.