Background High demand for ambulance care has led to changes in service provision, with calls identified as lower urgency increasingly being dealt with by telephone advice. A systematic review identified evidence of the feasibility of ambulance telephone advice but found little evidence around dimensions of quality e,g, safety This study uses interviews with service providers to explore the safety, appropriateness and acceptability of ambulance telephone advice. Methods Semi-structured interviews were undertaken with 16 staff involved in the telephone advice process, including Call Handlers, Clinical Advisors and staff with a strategic service overview. Interviews were undertaken in one English ambulance service during the last quarter of 2020. Definitions of safety, appropriateness and acceptability were developed from a narrative review and applied to the interview findings. Interviews were analysed thematically using Framework. Results Service provider interviews identified safety mechanisms at service, team and individual levels that enhance safety e.g. call auditing, clinical governance processes, multi-disciplinary Clinical Advisor team, and providing all calls with advice about what to do if a problem worsens. However, some staff perceived some gaps in service safety relating to under-triage, long waits for a clinical call back and concerns about the triage Concerns Process. Interviewees perceived telephone advice as mostly appropriate but identified mental health calls as very challenging for non-mental health specialists. Interviewees perceived user acceptability of telephone advice as mixed and linked to expectations around receiving an ambulance, whether the caller is reassured and length of time to receive a clinical call back. Conclusions Service providers perceived that telephone advice was mostly a safe and appropriate method of handling lower urgency calls. The introduction of mental health nurses to the Clinical Advice team was perceived as beneficial to the overall safety and appropriateness of mental health calls.

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02 服务提供商对紧急呼叫救护车服务电话建议的安全性、适当性和感知可接受性的看法

背景 对救护车护理的高需求导致了服务提供的变化，越来越多地通过电话咨询来处理被确定为较低紧急情况的呼叫。一项系统评价确定了救护车电话咨询可行性的证据，但在质量维度（例如安全性）方面几乎没有证据。这项研究通过与服务提供者的访谈来探讨救护车电话咨询的安全性、适当性和可接受性。方法 对参与电话咨询过程的 16 名工作人员进行半结构化访谈，包括呼叫处理人员、临床顾问和具有战略服务概览的工作人员。采访是在 2020 年最后一个季度在一个英国救护车服务中进行的。安全的定义，适当性和可接受性是从叙述性审查中得出的，并应用于访谈结果。使用框架对访谈进行主题分析。结果 服务提供商访谈确定了提高安全性的服务、团队和个人层面的安全机制，例如呼叫审核、临床治理流程、多学科临床顾问团队，并为所有呼叫提供有关问题恶化时应采取的措施的建议。然而，一些工作人员认为与分诊不足、等待临床回电的时间长以及对分诊关注流程的担忧在服务安全方面存在一些差距。受访者认为电话咨询最合适，但认为心理健康电话对非心理健康专家非常具有挑战性。受访者认为用户对电话建议的接受程度参差不齐，并且与接收救护车的期望、呼叫者是否放心以及接收临床回电的时间长短有关。结论 服务提供者认为电话咨询主要是处理较低紧急呼叫的安全和适当的方法。将心理健康护士引入临床咨询团队被认为有利于心理健康呼叫的整体安全性和适当性。