Ambulance Design for Patient Safety
In March 2005, the National Patient Safety Agency (NPSA) prioritisation panel strongly supported a project on ambulance design to be taken forward in the coming year in response to concerns relating to the design of vehicles and equipment that impact on patient safety.
In June 2005, the Department of Health set out a vision for the provision of future ambulance services by 2010. This included providing an increasing range of quality mobile healthcare services for patients with urgent and emergency care needs.
The overarching aims are that patients will receive improved care by consistently receiving the right response, first time, in time, and that more patients will be treated in the community, resulting in more effective and efficient use of NHS resources. It seems likely that these changes will require different vehicles and equipment for ambulance services.
This first scoping study aimed to investigate the developing models of service provision in the Ambulance Service, and the short and long-term requirements of vehicles and equipment needed to address the concerns of patient and staff safety in the future.
Three types of data were collected: archival incident reports, research literature and empirical data from workshops. The archival data were collected from three sources about reported incidents relating to ambulance, ambulance equipment design and use, and patient and staff safety. The research literature review was used to not only set out the background context but also to develop the conceptual framework for the analysis of the workshop data. Empirical data were collected from four user workshops.
A dataset of 1,352 incidents was received from the National Reporting and Learning System (NRLS) database and 1,259 were retrieved from the Manufacturer and User facility Device Experience (MAUDE) database. Ten ambulance trusts responded to a request for information (from the 32 trusts contacted).
The incidents were scrutinised individually and initially coded to provide a framework for discussion at user workshops. After the analysis of the workshop data, the incident reports were reviewed and coded into the nine design challenges. The data from the workbooks at the strategic workshop were analysed thematically to identify six core areas of service provision.
These areas of service provision were used as the discussion framework at the manufacturer and operational workshops. The data from the operational workshops were coded in two stages to allow for iterative analysis and further exploration of codes and themes. The coding by Roger Coleman/Merih Kunur resulted in two distinct design outputs for (1) design issues and (2) problems/ features. These codes were then scrutinised by Emma Crumpton, resulting in the 31 codes. At this stage a detailed secondary coding was conducted within the codes to identify nine higher level codes and address duplication between codes (Emma Crumpton/Sue Hignett). These design challenges were further checked against the primary coding by Sue Hignett to confirm inclusiveness. The results of this study were communicated in two publications.