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Time-and-motion study of community paramedics in an Australian ambulance service
Matt Wilkinson-Stokes1, Dianne Crellin1, Celene Y L Yap1
1University of Melbourne, Melbourne, VIC, Australia.
Background:
For over 30 years ambulance services have used the community paramedic (CP) model, in which paramedics receive additional education and deliver specialist interventions to manage non-emergency patients. This study empirically quantifies their actions with patients.
Methods:
An independent observer conducted continuous time-and-motion workflow observations of CPs over 22 consecutive days. Results were bootstrapped, descriptive and inferential statistics reported, and the structure of the standard case mapped.
Results:
A total of 77 patients were observed for 5496 minutes. Mean on-scene time was 55 min (range 20-98, 95 %CI 54-56). Time was 56 % spent either completing paperwork or transporting, 28 % gathering data, 9 % discussing options, and 7 % providing interventions. The most common vital signs were heart rate/Sp02 (96 %), blood pressure (90 %), and temperature (81 %); others were measured in under 40 % of patients. Specialist scope was utilised in 16 % of patients, involving 8 of 24 available interventions. Overall, 57 % of patients were transported (51 % ED, 6 % urgent care), and 13 % were referred onwards.
Conclusions:
This study provides insight into how CPs spend their time with patients. Results suggest that interactions focus on assessment and decision-making rather than specialist interventions; that this is a 'thinking' rather than a 'doing' role.
