Decision Making and Safety in Emergency Care Transitions

Dr Rachel O'Hara


NETSCC, Health Services and Delivery Research Programme (NIHR HS & DR) (link)

Project Overview

A significant increase in demand for emergency care over the last decade has led to a number of changes in the way pre-hospital emergency care is delivered.  These changes include the introduction of new staff roles within ambulance services and an increase in the options for patient care.  Delivery of care involves multiple decisions that are made within challenging circumstances for staff and service users.  This study aims to identify areas of high risk regarding decision making about service user options.


  • Map the emergency care system in a sample of Ambulance Services.
  • Conduct an ethnographic investigation of factors influencing decision making by ambulance service staff.
  • Feedback of study findings to participating ambulance services and stakeholders.

Study Design

An organisational case study approach will use a range of qualitative methods to explore influences on safe decision making during key emergency care transitions.

  • Interviews with key members of staff at participating Ambulance Services.
  • Ethnographic methods (observation, interviews, diaries) involving operational Ambulance Service staff.
  • Focus groups with operational Ambulance Service staff.
  • Focus groups with service users.
  • Feedback workshops.

The study was completed on 31st October 2013. 


[Project report] O'Hara R, Johnson M, Hirst E, Weyman A, Shaw D, Mortimer P, et al.A qualitative study of decision-making and safety in ambulance service transitions. Health Serv Deliv Res 2014;2(56) (link)

O'Hara R, Johnson M, Siriwardena AN, et al. A qualitative study of system influences on paramedic decision making: care transitions and patient safety. J Health Serv Res Policy 2015; 20(1S). (link)

Project Management Team

Dr Rachel O'Hara (Principal Investigator) Email:  Tel: 0114 2220680

Ms Maxine Johnson (Research Fellow) Email:  Tel: 0114 2220850

Mrs Sue Wilson (Project Administrator) Email:  Tel: 0114 2220776


Prof. Suzanne Mason, ScHARR

Ms Janette Turner, ScHARR

Mrs Enid Hirst, Public & Patient Representative

Prof. Niro Sirwardena, University of Lincoln

Prof. Tom Quinn, University of Surrey

Mrs Jane Shewan, Yorkshire Ambulance Service

Dr Andrew Weyman, University of Bath