Current methods to evaluate the delivery of urgent prehospital care often rely on inadequate surrogate measures or unreliable self-reported data (Nielsen 2012). A workplace-based strategy may be feasible to assess the delivery of prehospital care by ambulances in selected populations.
To perform a nationwide assessment of the psychomotor performance of public ambulance workers in Ukraine, we created a plan of workplace-based observation. We conducted a post-hoc analysis of this strategy to assess suitability, strengths, and limitations for future use in assessing prehospital ambulance performance.
With support from the Ministry of Health, we sent teams of trained observers to 30 ambulance substations across Ukraine. Using data collection tools on mobile devices, these observers accompanied Advanced Life Support ambulances on urgent calls for periods of 72 hours. We assessed the feasibility of this strategy for collecting patient encounter data when weighed against the investment of time, personnel, and financial resources.
Over a 2-month period, we directly observed 524 patient encounters by public ambulances responding to urgent calls at 30 ambulance substations across Ukraine. We employed 6 observers and 2 administrators over this time period. Collecting our observations required 2,160 person-hours at the ambulance substations. The total distance travelled to these sites was 11,375 kilometers. Project costs amounted to 37,000 USD, equating to 71 USD per observed patient encounter.
Workplace-based assessments are a cost-effective strategy to collect data on the delivery of prehospital care in select populations. This data can be useful for identifying the current state of EMS care delivered and evaluating compliance with established treatment protocols.
Successful implementation depends on effective planning and coordination with a commitment of time, personnel, and financial resources. Issues of patient privacy, legal implications, and observer training must be considered.
Katie Nielsen, Charles Mock, Manjul Joshipura, Andres M. Rubiano, Ahmed Zakariah & Frederick Rivara (2012) Assessment of the Status of Prehospital Care in 13 Low- and Middle-Income Countries, Prehospital Emergency Care, 16:3, 381-389.