​Prehospital clinicians are often the first to assess and treat critically unwell children, making crucial decisions under pressure and initiating vital interventions. Despite being a key part of a child’s emergency care journey, they rarely receive feedback on their clinical management or the patient’s outcome once care is handed over in the emergency department.

Many prehospital clinicians report feeling anxious and lacking confidence when caring for younger patients. Paramedics have highlighted the need for more targeted paediatric education, better access to prehospital clinical decision-making tools, and stronger support from NHS Trusts to help guide and inform their care.

While it’s widely accepted that additional, focused paediatric education is essential to building confidence among prehospital clinicians, there is little consensus on the best way to deliver it [2]. A recent study suggests that combining training with structured feedback from emergency departments may be particularly effective [4]. Personalised feedback, in particular, is a valuable and impactful learning tool [2,5].

In response to this need, emergency clinicians at the Bristol Royal Hospital for Children’s Emergency Department (BRHC CED) launched the ‘SWAST Feedback Project’ in September 2022. The initiative offers on-demand, tailored feedback to paramedics and other prehospital clinicians, aiming to build confidence and improve the care of paediatric patients in the prehospital setting.

The SWAST Feedback Project aims to give prehospital clinicians easy access to structured, personalised, and focused written feedback. Clinicians can request feedback on any paediatric case they’ve attended. While feedback often centres on clinical management, diagnosis, or patient outcomes, it can also be tailored to the specific questions or learning needs of the individual making the request.

In parallel, a monthly education programme – EasyPaedsy -has been developed, shaped by themes emerging from the SWAST Feedback Project. These virtual teaching sessions focus on the clinical presentations and conditions most commonly highlighted by prehospital clinicians. Sessions are delivered by local senior clinicians in paediatric emergency medicine and are designed to be accessible and practical. Feedback is collected after each session, and both facilitators and attendees receive continuing professional development (CPD) certification.

If you want to know how to create a similar project in your own Emergency Department, please read the article below! 

Follow our step-by-step guide below:  

1) Build your project group and delegate roles 

Assembling your project group 

The project group should have a range of emergency medicine clinicians, including: 

• Senior clinicians (minimum of 2) 
• Consultants.  
• Senior resident doctors e.g., ST6+ (UK equivalent)
• Tier 2 doctors (minimum of 2) 
• Middle grade resident doctors.  
• e.g., ST3 + (UK equivalent).
• Tier 1 doctors (minimum of 2) 
• Junior grade resident doctors. 
• e.g., FY1, FY2, ST1/2 or SHO grade doctors (UK equivalent)

Other healthcare professionals

• Nursing or Allied Health professionals are actively involved in supporting the project and providing education – see ‘EasyPaedsy’ below.

• Examples: Mental health practitioners, Clinical nurse specialists, Advanced nurse practitioners, Advanced clinical practitioners, Physiotherapists etc.

Delegating roles 

 All emergency medicine clinicians involved in the ‘SWAST Feedback Project’ have equal responsibility for completing the feedback requests submitted by prehospital clinicians. 

There are also more specific roles within the project. 

• Project leaders – responsible for chairing meetings and taking overall project lead. 
• Feedback Rota leads – responsible for creating a feedback response rota – two clinicians each week. Ensuring workload is allocated fairly amongst group members. 
• Teaching programme leads – responsible for organising and hosting the prehospital monthly teaching sessions. 
• Academic leads – responsible for data collection. Responsible for abstracts, posters and presentations for conferences
• Secretary – responsible for project meeting minutes, teacher certificates and feedback. 

2) Set up a central data collection survey 

Step 1

Selecting the right platform to securely collect case details is a crucial early step. It’s important to ensure that your data collection methods align with local NHS Trust data protection policies and comply with GDPR.

For the SWAST Feedback Project, we used REDCap, a secure, web-based application designed to support data capture for research and quality improvement initiatives [6,7]. REDCap allows you to build custom surveys and collect data in a structured, user-friendly format. In our case, the system was hosted by University Hospitals Bristol and Weston NHS Foundation Trust.

Step 2 

Create a survey for prehospital clinicians using the data collection programme.

Step 3

Once your data collection platform is set up, consider generating a QR code linked to the survey to make access as simple as possible. Displaying this prominently in your emergency department—particularly in areas where prehospital staff routinely hand over patients—can help raise awareness and encourage engagement with the feedback system.

Step 4 

To complete the feedback loop, create a follow-up survey that allows project team members to provide written feedback in response to requests. This form should be straightforward to complete and designed to capture the key clinical details, reflections, and learning points relevant to the case.

3) How to respond to feedback requests  

Step 1– What was the likely diagnosis? 

The most likely diagnosis was ‘Croup’ 

Step 2 – Summary of patient hospital journey

A brief summary of the patient’s clinical course is often the most helpful component of the feedback. The discharge letter usually provides a clear and concise overview, making it a valuable resource when composing this section.

‘Dear [name of prehospital clinician]   

Thank you for your interest in following up this patient.  

Lily was a 2-year-old girl who presented with stridor when upset and a barking cough on a background of two days of coryzal symptoms.   She received 0.15mg/kg of dexamethasone on arrival into the emergency department which improved her symptoms.   

She was observed for 4 hours in the emergency department with no recurrence of stridor or increased work of breathing.  

She was discharged home as per our ‘Croup guidelines’.

Step 3 – Tailored feedback to meet individual learners’ needs  

Prehospital clinicians have the opportunity to ask their own questions about the case. Common questions include

• ‘Could I have given any other treatments?’ 
• ‘How was my prehospital assessment of the patient?’ 
• ‘Were the prehospital treatments given correct?’ 

‘This patient’s diagnosis was likely Croup.

Your prehospital assessment appropriately highlighted the need for them to be conveyed to hospital.
You could have considered giving dexamethasone whilst conveying the patient to hospital if you were concerned about stridor at rest.

Attached is the ‘Croup guideline’ we use within the emergency department to use as a reference point for future practice’.

Step 4 – ‘Significant cases’  

Certain clinical cases are highlighted as significant if one (or more) of the aspects below are met: 

– Trauma related cases (major trauma, major haemorrhage etc). 
– Patients requiring critical care or significant prehospital intervention. 
– Out of hospital cardiac arrest or sudden unexpected death (at any age). 
– Significant safeguarding concerns. 
– Predicted poor patient outcome. 
– Complex scene including significant police involvement or possible ongoing criminal investigations (where clinicians may need to provide statements or evidence).
– Presentation as part of a major incident.

The person providing feedback should then select the significant case button on REDCap.

This will automatically notify senior project group members via email to further evaluate the case.  The project group member who first identifies the case as significant then sends an initial reply to the prehospital team. 

Thank you … (insert name) for submitting a request for case feedback. 

Provide a short summary of the case in two or three sentences

The case you have requested feedback on has been identified as a significant case and will require additional time to collate feedback for you. This may be because there is information about the case which is not yet available, and we wish for our feedback to be as complete as possible. 

We will endeavour to reply to your request within one month. If you do not hear from us, please contact us via [group project email]’.

The senior project group member then follows a standard operating procedure: 

Responding to specific questions in this way allows the feedback to be more appropriate, relevant, and comprehensive. It also creates an opportunity to offer wellbeing support to prehospital clinicians where needed, and to identify or escalate any potential clinical governance concerns that may arise from the case.

4) Liaise with your local ambulance service  

Engage early with your local ambulance service to discuss the aims, methods, and intended outcomes of your feedback project. For us, this was the South Western Ambulance Service NHS Foundation Trust (SWAST).

Identifying key stakeholders—such as ambulance education leads—can be especially helpful in promoting the project and building collaborative momentum. In our case, this partnership also led to the development of the EasyPaedsy education programme, designed in response to feedback themes.

We worked closely with SWAST education leads to support, advertise, and help deliver the monthly sessions.

How we set up the education programme- ‘EasyPaedsy’  

1) Identify teaching topics

Begin by developing a list of suitable paediatric topics for your teaching sessions. This can be guided by the clinical cases, presentations, and themes that prehospital clinicians most often request feedback on. Collating commonly asked questions can also help shape content—these may vary throughout the year, with respiratory presentations more frequent in winter, for example. Ongoing feedback from session attendees is another valuable tool for planning future topics, ensuring the programme remains responsive and relevant.

See below for examples of the teaching sessions in our programme:

Abdominal pain
Anaphylaxis
Bronchiolitis and croup
Congenital Cardiac Abnormalities
Fever and Sepsis
Fits, Faints and Funny Turns (including BRUEs)
Head Injuries
An approach to trauma
Mental health in young people
Safegaurding
Seizures
Supporting children with special needs

2) Create a teaching timetable

Choose a regular slot e.g., the first Monday of every month

3) Recruit a presenter and supervisor for each session

Promote this multidisciplinary teaching opportunity to staff within your emergency department to encourage wide participation.

Teaching sessions are typically delivered by senior paediatric trainee doctors (ST3+ level) or allied health professionals with relevant expertise, such as specialist nurses or mental health practitioners.

Each session is supported by a consultant-grade supervisor—either in paediatrics or paediatric emergency medicine—who is on hand to oversee the teaching and respond to clinical questions from attendees.

4) Deliver teaching sessions 

Before session

One to two weeks before each session, send reminders to the presenter, session supervisor, and local ambulance service contacts—such as education leads at SWAST—to confirm their involvement.

At the same time, share the session link with both hospital and prehospital colleagues to encourage attendance and ensure wide multidisciplinary participation.

During the session

Each EasyPaedsy teaching session lasts between 60 and 75 minutes and is delivered virtually to maximise flexibility for both presenters and attendees.

This format allows prehospital clinicians from across the region to join easily and supports the involvement of a broad range of speakers. Interactive tools—such as Mentimeter (mentimeter.com)—are used throughout to encourage participation and consolidate learning.

Alongside the presenter and supervising consultant, a member of the project team and a local ambulance service representative (such as a SWAST education lead) attend each session to help facilitate discussion and manage any technical issues.

Feedback is collected at the end of the session via a QR code, helping to guide future content and improve delivery.

5)  Prepare feedback forms and certificate templates 

At the end of the session collect feedback from attendees via a QR code. Specific areas (pre- and post- session) include:

• ‘How confident are you in this topic?’
• ‘How useful did you find the session?’
• ‘Was the topic pitched at the right level?’ 
• ‘How would you improve future sessions?’

Rating scales are excellent at quantifying impact of the teaching sessions

6) Create certificates 

Provide certificates for both attendees and presenters, which they can use to support their professional development and maintain their portfolios.

Using an online platform that generates certificates automatically – triggered by the completion of a feedback form – can help increase response rates and streamline the process.

Feedback submitted by attendees should also be summarised and shared with presenters to support their growth and development as educators.

And don’t forget to send the teacher their certificate, too!

7)  Collate and review session feedback 

Regularly review attendee feedback to identify areas for improvement and ensure the teaching sessions continue to meet learners’ needs. As outlined in Step 1, collate any suggested topics and use these insights to guide and adapt future sessions, keeping the programme relevant and responsive to evolving clinical challenges.

8) Advertise and launch your project!

Advertise to prehospital colleagues attending your department……and get started!

Do you want to read more about the outcomes from our project?

We have also published a summary of our project – take a look here.