Table 2 Themes, categories, and sub-categories with illustrative quotations
Theme | Category | Sub-categories | Illustrative quotation |
|---|---|---|---|
1. Types of decisions made | 1.1. Transport? | Transport; Leave patient at scene | “I started taking more patients to the hospital because it’s impossible to make a proper assessment with the diagnostic tools we have.” (P2) |
1.2. Treatment? | Administer treatment; Do not administer treatment | “For some conditions, those ‘half-conditions’, where I can’t be sure what’s happening without more diagnostics… I don’t know what to do with those patients. I would rather just transport them to the hospital for further diagnostic tests as I feel giving them therapy might do more harm than good.” (P1) | |
1.3. How to transport and/or treat? | Choice of transport and/or treatment | “Sometimes my decision depends on how far away we are from the hospital. Is it more important to bring the patient to hospital as fast as we can so he can get full diagnostics and treatment, or to spend 10 more minutes on the field to follow all the steps from the guidelines?” (P7) | |
2. Factors that influenced decision-making | 2.1. Physician-related | Learning journey; Emotions; Fatigue, burnout, and suicide; Personal values | “It’s all nice when we are relaxed and we go to work well-rested, no frustrations, then we are more objective. But when we have all these other things…when we are depressed, frustrated, we don’t sleep well, we are not satisfied…then we react abruptly, communication is worse, negative energy is created between patients and us, and then the treatment of the patient suffers.” (P17) |
2.2. Patient-related | False statements; Violent behavior; Complaints and lawsuits | “Lawsuits are not as common as complaints to our employer…they happen often. Yes, people like to report us. But it’s not only reporting, there are also threats and violence, verbal and physical. We find ourselves in very uncomfortable situations. It’s enough if a doctor loses his license once to suffer the consequences for the rest of his life. It’s what we all fear. We feel very exposed, and we make decisions based on that fear.” (P7) | |
2.3. Organization-related | Training; Feedback; Diagnostic and treatment tools; Guidelines; Team dynamic; Relationship with management | “My experience doesn’t mean much if I keep doing the same thing without knowing if it’s the right or wrong thing to do… I can keep repeating mistakes if nobody tells me that it led to a bad outcome for the patient… Feedback is important to build my experience and to use for further work.” (P21) “It would be ideal if leadership would spend some time in the field… I think it would be easier if they could identify with workers on the field, if they would understand them…working conditions would be better for sure…they would show more empathy towards difficulties workers go through and treat them better.” (P12) | |
2.4. Health care system-related | “Grey-zone” situations; Emergency services overcrowding; Tensions at patient handovers | “Given that OHEMS should not really deal with this, as it should be covered by GP’s and palliative team house visits, there are no clear guidelines for us.” (P15) | |
3. Perceived quality of work and patient care | 3.1. Variability in decision-making | Absence of diagnostic and treatment tools; Lack of clear guidelines and work protocols; Inadequate feedback and quality control mechanisms; High turnover rate | “There shouldn’t be such variability in our work because it influences the quality of care. Patients should not be treated differently depending on who comes to their house.” (P21) |
3.2. Medical errors | Malfunctioning equipment; Untimely care; Unnecessary treatment | “Increased demand leads to overcrowding the system, which leads to fatigue and slows down the work, so some real emergencies might wait too long, and increase patient mortality as a result.” (P20) | |
4. Decision-making support desired | 4.1. Organization-related | Training; Feedback; Guidelines; Team dynamic; Relationship with management | “The Institute could publish their own revised and modified guidelines, depending on the available equipment.” (Participant 14) |
4.2. Health care system-related | Primary healthcare reform; Health literacy; Work environment; Coordination between different public services | “There should be a system that would connect hospital, OHEMS, and family medicine… because elderly patients mostly can’t tell you which medications they are taking, so it would be easier to check that information in the system. Also, it would be good to know if you made the right decisions and what happened to the patients after you took them to the hospital. That would give us moral satisfaction and would help us learn.” (P8) |