Variation in Ambulance Pre-Alert Process and Practice: Cross-sectional Survey of Ambulance Clinicians

Background Ambulance clinicians use pre-alerts calls to alert emergency departments (EDs) about the arrival of critically ill patients. We explored ambulance clinician’s views and experiences of pre-alert practice and processes using a national online survey. Methods Ambulance clinicians involved in pre-alert decision-making were recruited via ambulance trusts and social media to complete an anonymous online survey during May-July 2023. Quantitative data was analysed descriptively using SPSS and text data was analysed thematically to illustrate quantitative findings. Results We included 1298 valid responses from across 10 ambulance services. Analysis identified variation in practice at all stages of the pre-alert process, including reported frequency of pre-alert (7.1% several times a shift, 14.9% once/twice a month). Most respondents reported that pre-alerts were delivered directly to the ED but 32.8% reported pre-alerting via an ambulance control room. Personal mobile phones were used to make a pre-alert by 46.8% of respondents, with 30% using ambulance radio. A third of respondents always used mnemonics (e.g. ATMIST/SBAR) but 10.2% reported not using any fixed format. Guidance used to identify patients for pre-alert varied between clinicians and ambulance service, with local ambulance service guidance most commonly used and 20% stating they never use national guidelines. Respondents reported variable understanding of appropriate conditions for pre-alert and particularly students wanted further guidance on silver trauma and medical pre-alerts. Only 29% or respondents reported receiving specific pre-alert training and 50% reported never receiving feedback. Fewer than 9% reported always being listened to and having the call taken seriously. Conclusion We identified variation in pre-alert processes and practice that may result in inconsistent pre-alert practice and challenges for clinicians providing time critical care. Guidance and training on the use of pre-alerts may promote more consistent processes and practices. WHAT IS ALREADY KNOWN ON THIS TOPIC WHAT THIS STUDY ADDS HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement National Institute for Health and Care Research (NIHR HS&DR 131293). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: NHS ethics North East - Newcastle & North Tyneside 2 Research Ethics Committee 21/NE/0132 Ethics approval granted I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript