Paramedic information needs in end-of-life care: a qualitative interview study exploring access to a shared electronic record as a potential solution

Background: Limited access to, understanding of, and trust in paper-based patient information is a key factor
influencing paramedic decisions to transfer patients nearing end-of-life to hospital. Practical solutions to this
problem are rarely examined in research. This paper explores the extent to which access to, and quality of, patient
information affects the care paramedics provide to patients nearing end-of-life, and their views on a shared
electronic record as a means of accessing up-to-date patient information.
Method: Semi-structured interviews with paramedics (n = 10) based in the north of England, drawn from a group
of health and social care professionals (n = 61) participating in a study exploring data recording and sharing
practices in end-of-life care. Data were analysed using thematic analysis.
Results: Two key themes were identified regarding paramedic views of patient information: 1) access to
information on patients nearing end-of-life, and 2) views on the proposed EPaCCS. Paramedics reported they are
typically unable to access up-to-date patient information, particularly advance care planning documents, and
consequently often feel they have little option but to actively treat and transport patients to hospital – a decision
not always appropriate for, or desired by, the patient. While paramedics acknowledged a shared electronic record
(such as EPaCCs) could support them to provide community-based care where desired and appropriate, numerous
practical and technical issues must be overcome to ensure the successful implementation of such a record.
Conclusions: Access to up-to-date patient information is a barrier to paramedics delivering appropriate end-of-life
care. Current approaches to information recording are often inconsistent, inaccurate, and inaccessible to
paramedics. Whilst a shared electronic record may provide paramedics with greater and timelier access to patient
information, meaning they are better able to facilitate community-based care, this is only one of a series of
improvements required to enable this to become routine practice.