Background Paramedics report unique challenges delivering end of life care, including accessing education and low confidence (Pettifer & Bronnert, 2018). NHS Ambulance Services cover large geographical areas and education is typically centralised.
Project ECHO™ (Extension of Community Healthcare Outcomes) utilises a tele-mentoring network to develop virtual communities of practice to enable case-based learning to manage complexity across geographically challenged services.
Prior Project ECHO™ implementations have demonstrated improved competence, confidence and patient related health outcomes (Arora, Kalishman, Thornton, Dion et al., 2010; Zhou, Crawford, Serhal, Kurdyak et al., 2016).
Aim To develop and deliver an effective end of life care training and education programme for paramedics using ECHO™ methodology.
Methods A virtual approach was utilised to support participant engagement, recruitment, knowledge events, ECHO™ sessions and evaluation. Two programmes of five sessions, occurring monthly were facilitated by a Consultant Palliative Physician and Consultant Paramedic. Participants ‘dialled in’ remotely using Zoom. Each session comprised an expert talk and two anonymised case presentations from participants, forming the basis for facilitated discussions.
Electronic surveys based on end of life care and paramedic research (Smith, Arnold, Kinghorn, Poppleton, 2010) were: a knowledge questionnaire on recruitment; self-completed training needs analysis of competence and confidence at the start, midpoint and end, and individual session evaluations for session quality and fidelity to the model.
Results Programme 1:
Statistically significant improvements (p>0.05) in self–reported competence and confidence across all five sessions and end of life care competencies;
Attendance ranged from 60–93%;
Potential travel cost savings were £2215.08 (4922.4 miles);
Development of a multi–professional virtual community of practice: paramedics, physiotherapists, occupational therapists, consultants and GPs understanding each other’s roles and challenges;
No major IT access, sound or vision problems identified and participants highly rated ECHO™ session delivery by the hub team.
Programme 2: results under analysis.
Conclusions Attendance and recruitment rates indicate that ECHO™ is an accessible model of education delivery. A multi-professional virtual community of practice was developed. Survey findings support the successful application of this model to paramedics delivering end of life care, resulting in statistically significant improvements in self-reported competence and confidence.
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