16 Emergency medical services physicians’ perceptions of ambulance nurses’ responsibility for referring patients to primary care and self-care – a swedish national survey

• Published in: BMJ open 2018-04, Vol.8 (Suppl 1), p.A6-A6
• Main Authors: Bremer, A, Kowalczyk, E, Årestedt, K, Wireklint Sundström, B
• Format: Article
• Language: English
• Subjects: Activities of daily living; Medical referrals; Nurses; Patient safety; Perceptions; Physicians; Primary care
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2018-EMS.16

AimBased on guidelines developed by EMS physicians, registered nurses in the Swedish ambulance services sometimes by-pass the emergency department and refer non-urgent patients to primary care and self-care. However, these referrals are associated with problems that may jeopardise patient safety and patient participation. The aim was to identify the EMS physicians’ perceptions of ambulance nurses’ responsibilities and prerequisites to refer patients to primary care and self-care.MethodA national survey of all EMS physicians (n=51) using study specific questions with close-ended and open response options, analysed with descriptive statistics and thematic analysis.ResultsThe response rate was 78% (n=40). The majority of the physicians (95%) perceived that nurses should be able to refer patients to primary care and self-care. One fourth (25%) perceived specialist nurses in ambulance care as the most appropriate professionals. The majority of the physicians (65%) perceived that referral to primary care maintain patient safety, whereas fewer (50%) assessed the referral as safe for the patient. All perceived that feedback should be given to nurses when the referral was incorrect. The majority perceived it important to extend the nurses’ authority to refer to primary care (63%) and self-care (55%).ConclusionThere is no consensus among the EMS physicians regarding responsibilities and conditions for nurses’ referral of patients. Registered nurses with basic education are expected to be able to refer, while there is varying opinion regarding requirements of specialist trained ambulance nurses to refer patients. Professional experience as a nurse is perceived more important than formal education.Conflict of interestNoneFundingDivision of Emergency Medical Services, Helsingborg County Hospital, Helsingborg, Sweden.