Pre-alerts summary

When a patient is seriously ill, ambulance staff may call the Emergency Department (ED) to let them know the patient is on their way. This is known as a ‘pre-alert’ and can help the ED to free up a trolley space or bed and get specialist staff ready to treat the patient as soon as they arrive. If used correctly, pre-alerts can help to provide better care, earlier access to time-critical treatment and improved outcomes for patients. However, if pre-alerts are used for the wrong patients, or used too often, then the ED staff may not be able to respond properly and may stop taking them seriously.

When ED staff prepare for a pre-alerted patient, they may have to move patients who are less seriously ill, and take staff away from other work. It is therefore important that pre-alerts are only used when absolutely necessary. There is some guidance telling ambulance staff who they should do pre-alerts for, and how this should be done. However, the guidance is not always clear and varies for each ambulance service. This creates a risk that ambulance staff may not pre-alert appropriate patients, or may pre-alert when it isn’t necessary. This may cause difficulties for the ED and tensions between ambulance and ED staff. There are important risks for patient safety.

Although pre-alerts are being used more often, little is known about how they are used, who they are used for or how the EDs respond to them. Given how important pre-alerts are for patient safety it is important that we understand the impact of pre-alerts on patients, ambulance staff and ED staff.

We propose to do some research to understand how pre-alerts take place at the moment and how this varies between ambulance services and between different types of ambulance staff. We will try to identify how the processes of doing pre-alerts can be improved and identify areas of good practice. We will do this within 5 separate research activities. We will involve patients and the public in designing and carrying out this research.

1. We will look at existing ambulance service policies and data to understand how pre-alerts are currently being done, and what may be causing variation.
2. We will talk to ambulance staff to understand how they decide to make pre-alert calls and which patients are difficult to decide whether to pre-alert. We will also ask what information they give to the Emergency Department staff, and how they expect Emergency Department staff to respond. We will explore findings from these interviews in a survey of all ambulance staff in 3 ambulance services to identify areas where they need improved guidance.
3. We will talk to staff in Emergency Departments and watch them taking pre-alert calls. This will help us to understand how they use the information given in a pre-alert to change what they do, and to understand what makes a useful pre-alert.
4. We will talk to patients and their friends and family to find out what they understand about pre-alerts, what they are told about pre-alerts and whether this changes their expectations once they arrive in hospital.
5. We will discuss the findings from this research in a national workshop with key people, including patients and the public, to identify how pre-alerts can be improved. We will produce short, written guidance to ambulance and Emergency Department staff about how they should manage pre-alerts in future. We will identify key areas of uncertainty that should be addressed within future national guidance.