PP24 Prehospital feedback in the United Kingdom: protocol for a review of current practice using a realist approach

Background: Prehospital feedback is increasingly receiving attention from clinicians, managers and researchers. The effectiveness of feedback in changing professional behaviour and improving clinical performance is strongly evidenced across a range of healthcare settings, but this has not yet been replicated within the prehospital context. Without a firmer evidence base, development in practice relies on isolated initiatives with no clear intervention model or evaluative framework. The aim of this study is to understand how UK ambulance services are currently meeting the challenge of providing prehospital feedback and generate an explanatory programme theory. Methods: This mixed methods study will follow a realist evaluation methodology framework with an explanatory case study research design. A realist approach was selected as it will facilitate development of programme theory by exploring context, mechanisms and outcomes. The study will consist of three phases: a pilot case study, a national survey and three in-depth case studies. Phase 1 and 3 of the study will involve semi-structured qualitative interviews and site visits, whilst phase 2 will consist of a cross-sectional survey sent out to leads of UK prehospital feedback initiatives. This study will draw upon a range of existing theories to aid understanding such as the Consolidated Framework for Implementation Research, Normalisation Process Theory and Clinical Performance Feedback Intervention Theory. Results and Conclusion: The three phases of this study will allow for cyclical development, testing and refinement of programme theory by describing existing prehospital feedback intervention types and variations in implementation, as well as evaluating their causal mechanisms and outcomes. Study findings will facilitate an understanding of the extent and limitations of current initiatives, with a view towards identifying opportunities for intervention