Ambulance clinicians' perceptions and experiences of managing risk during decision-making in care homes

Ambulance clinicians play a key role in decision-making when care home residents experience deteriorations in their health. An emerging evidence base suggests ambulance clinicians weigh up risk during decision-making but provides limited insights into how they do so. Therefore, this study aimed to explore ambulance clinicians' experiences of balancing and managing risk(s) when attending calls to care homes.

Online semistructured interviews were conducted with 22 ambulance clinicians working in a variety of roles across seven NHS Ambulance Trusts in the UK. Data were analysed thematically using a constructivist approach.

Three themes describe the ways ambulance clinicians manage risk when attending calls to care homes. The first theme outlines five forms of risk that ambulance clinicians weigh up, including risks to residents, themselves as decision-makers, their interpersonal relationships, their employing organisation and wider healthcare services. The second theme outlines the actions ambulance clinicians undertake to manage risk. Involving others in decision-making is a key action through which ambulance clinicians manage risk but doing so introduces the need to negotiate with others. Therefore, the third theme explores the multiple factors that shape ambulance clinicians' experiences of weighing up risks and negotiating with others. These factors align with the forms of risks ambulance clinicians manage during decision-making and include resident, decision-maker, interpersonal, organisational and systemic factors.

This study highlights the complexity involved in ambulance clinicians' decision-making in care homes. The findings identify a number of important implications for research, policy and practice. This includes the need for further work to develop cross-sector practices and policies of accountability, to improve the number and quality of advance care plans and to ensure the current and future ambulance workforce are equipped to undertake the complex negotiation work involved in managing risks during decision-making in care homes.