Time-and-motion study of community paramedics in an Australian ambulance service

Abstract

Background: For over 30 years ambulance services have used the community paramedic (CP) model, in which paramedics receive additional education and deliver specialist interventions to manage non-emergency patients. This study empirically quantifies their actions with patients.

Methods: An independent observer conducted continuous time-and-motion workflow observations of CPs over 22 consecutive days. Results were bootstrapped, descriptive and inferential statistics reported, and the structure of the standard case mapped.

Results: A total of 77 patients were observed for 5496 minutes. Mean on-scene time was 55 min (range 20-98, 95 %CI 54-56). Time was 56 % spent either completing paperwork or transporting, 28 % gathering data, 9 % discussing options, and 7 % providing interventions. The most common vital signs were heart rate/Sp0₂ (96 %), blood pressure (90 %), and temperature (81 %); others were measured in under 40 % of patients. Specialist scope was utilised in 16 % of patients, involving 8 of 24 available interventions. Overall, 57 % of patients were transported (51 % ED, 6 % urgent care), and 13 % were referred onwards.

Conclusions: This study provides insight into how CPs spend their time with patients. Results suggest that interactions focus on assessment and decision-making rather than specialist interventions; that this is a 'thinking' rather than a 'doing' role.

Keywords: Ambulance; Community Paramedicine; Emergency Medical Services; Paramedic; Time Motion Studies; Urgent Care.