Building educational networks through case feedback: Delivering bespoke, on-demand prehospital paediatric emergency clinical case follow-up
Prehospital clinicians in the UK—and globally—often report feeling anxious and underconfident when caring for paediatric patients. While there is widespread recognition that focused education is key to addressing this, there remains little agreement on the most effective way to deliver it.
Paramedics have consistently highlighted the need for more structured paediatric training, access to practical clinical decision tools, and greater support from NHS Trusts. A recent study highlighted the gap in confidence surrounding paediatric assessment and management, and recommended a combined approach of targeted training and follow-up feedback from emergency departments after handover. Personalised feedback, in particular, is a powerful tool for clinical learning and reflective practice [2,3].
In response to these challenges, emergency clinicians at the Bristol Royal Hospital for Children’s Emergency Department (BRHC CED) launched the SWAST Feedback Project in September 2022. This targeted educational initiative provides on-demand, tailored feedback to paramedics and other prehospital clinicians, aiming to enhance their confidence in caring for pediatric patients.
What did we do?
To request feedback, prehospital clinicians simply scan a QR code displayed on a poster in the emergency department. This opens a secure online survey where they can enter basic case details and specify the type of feedback they’re looking for. Options include feedback on the final diagnosis, inpatient progress, prehospital and ED management, and general paediatric learning points. This allows the feedback to be both case-specific and educational, covering clinical reasoning, paediatric practice, and practical management.
The SWAST Feedback Project uses REDCap (Research Electronic Data CAPture) as its data collection platform. REDCap is a secure, web-based tool designed to support high-quality data capture and management. It offers an intuitive interface for data entry, maintains audit trails, and supports secure data export for analysis and reporting. For this project, REDCap is hosted by University Hospitals Bristol and Weston NHS Foundation Trust.
The feedback requests come from prehospital clinicians working within the South Western Ambulance Service NHS Foundation Trust (SWAST). A small, consistent team of emergency clinicians then reviews each submission and provides timely, tailored feedback. This process is overseen by a paediatric emergency medicine consultant to ensure clinical governance and educational value. Feedback is written by a multidisciplinary group, including senior paediatric emergency medicine trainees, emergency medicine trainees, foundation doctors, and clinical fellows. After receiving their feedback, prehospital clinicians are invited to rate any changes in their confidence in clinical practice, supporting an evaluation of the project’s impact.
What were the results?
The project launched in September 2022, and since then, the project group members have responded to over 380 requests for clinical case feedback [data reviewed as of the time of writing this article, April 2025].
Most of these requests were from Band 5 newly qualified Paramedics (43%) or Band 6 Paramedics (40%). Other prehospital clinicians included Emergency care assistants (7%) and student paramedics (8%) (see Figure 1).
What kind of feedback are prehospital clinicians asking for?
The prehospital clinician can select multiple feedback options when completing the survey. Here were the most common feedback areas requested:
- ‘What was the diagnosis?’ – 81%
- ‘What did the emergency department do?’ – 69%
- ‘What happened to the patient on the ward?’ – 60%
- ‘Please can you provide feedback on the prehospital care of the patient?’ – 48%
What kind of cases are we giving feedback on?
The Bristol Royal Hospital for Children’s Emergency Department (BRHC CED) is one of only five dedicated, paediatric-only Major Trauma Centres in England and Wales, managing a broad range of clinical cases every day. Since the launch of the SWAST Feedback Project, feedback has been provided for 2.3% of all ambulance-conveyed patients—out of a total of 16,381 children brought to BRHC CED during the project period.
The most common presentation for which prehospital clinicians requested feedback was respiratory illness, accounting for 38.6% of all cases. Of these, 13.9% were viral upper respiratory tract infections (see Figure 2). This likely reflects the seasonal pattern seen in paediatric emergency departments, where respiratory presentations—particularly viral illnesses—are most prevalent during the winter months.
Following respiratory cases, the next most common feedback requests related to neurological presentations (27.3%), trauma (12.9%), and gastrointestinal problems (5.5%). These categories reflect the broad range of acute paediatric conditions encountered in the prehospital setting.
What do prehospital clinicians think of the feedback survey?
Prehospital clinicians felt that the feedback was ‘helpful’ or ‘very helpful’ in 99% of requests, with the majority (86%) stating that it would influence the clinicians’ future practice (Figure 3).
Feedback quotes from prehospital clinicians:
“For me, there was some diagnostic uncertainty in this case so it was very useful to hear what the ED diagnosis was. I find that this ‘closes the loop’ for me and helps me to develop my clinical acumen and diagnostic reasoning. Thank you so much.”
“Really thorough information, and very nice to hear some improvements/learning points that we as an ambulance clinician can take to alter practice”
“This service is invaluable for ambulance staff clinical development. Thank you :)”
How has the project developed?
The project has evolved in three key areas over time, providing continued and further educational opportunities.
Developed our ‘EasyPaedsy’ educational programme
Having identified trends in cases and clinical presentations from the feedback requests, the project group has set up the ‘EasyPaedsy’ education programme.
EasyPaedsy is a monthly virtual teaching programme developed in direct response to the themes and topics identified through feedback requests. Running since August 2024, the sessions are delivered by senior paediatric emergency clinicians alongside a range of local specialist speakers. The programme is a collaborative effort between our emergency department team and the education leads at South Western Ambulance Service NHS Foundation Trust (SWAST), ensuring it remains relevant and well-aligned with the learning needs of prehospital clinicians.
Since launching in August 2024, the EasyPaedsy teaching sessions have been attended by over 200 prehospital clinicians from across the South West of England. Topics have included Anaphylaxis and Allergy, Assessment of the Neonate, Croup and Bronchiolitis, and Paediatric Trauma—all reflecting common themes raised in feedback requests and areas of high clinical importance in the prehospital setting.
Qualitative feedback is collected after each EasyPaedsy session and plays a key role in shaping future content. Attendees receive continuing professional development (CPD) certificates, while presenters are provided with teaching certificates to support their professional portfolios.
Feedback from prehospital clinicians has been overwhelmingly positive. A total of 97.3% reported that the sessions were useful to their clinical practice, and 96.2% said they would recommend them to colleagues. Self-reported confidence in the topic increased by an average of 51% following the sessions, highlighting the programme’s impact on clinician confidence and learning.
Significant cases
As the project evolved, it became clear that some submitted cases were significantly more complex, unsurprising given the tertiary paediatric and major trauma centre setting. These cases often involved critical care, multiple specialist teams, and more complex diagnoses or prognoses. As a result, they required more detailed and considered feedback for the submitting prehospital clinician.
To support this, the team developed a case definition for what constitutes a significant case. These include patients involved in trauma, those with a predicted poor prognosis (such as out-of-hospital cardiac arrests), major safeguarding concerns, or presentations linked to major incidents.
A specific pathway was introduced to manage these cases. The feedback form was updated to allow clinicians to flag significant cases, which are then escalated to two senior project group members. These experienced emergency clinicians provide more comprehensive feedback at a later interval, allowing time for appropriate clinical reflection.
The process also includes a wellbeing review. If any concerns are identified regarding the emotional impact of the case on prehospital staff, these are escalated to the ambulance service’s wellbeing leads for follow-up and support.
Looking ahead, a key aim is to review these significant cases in more detail to identify further educational themes and opportunities for service improvement.
Clinical case exposure for responders
Responding to feedback requests has also proved valuable for the project team themselves. By reviewing a wide range of cases submitted by prehospital clinicians, team members are exposed to a broader spectrum of clinical presentations than they might encounter during their own shifts. This has helped to expand departmental awareness and enrich individual clinical experience.
Each case requires a member of the team to review the prehospital and emergency department documentation, identify key learning points, and craft tailored feedback, often supplemented with relevant educational resources. In doing so, the team not only supports prehospital colleagues but also engages in reflective learning based on real cases presenting to BRHC CED.
The development of the SWAST Feedback Project and its accompanying case feedback survey has been an educational experience for both those requesting and those providing feedback. The project has created a formalised yet flexible educational resource, allowing prehospital clinicians to explore their individual learning needs in relation to real paediatric cases.
For the project team, involvement has offered valuable exposure to the types of cases being brought to the emergency department by ambulance, particularly those that challenge or concern clinicians in the prehospital environment. This insight has helped strengthen the link between hospital and prehospital teams.
Beyond the feedback itself, the project has led to wider educational and developmental opportunities, including the launch of the EasyPaedsy teaching programme, designed specifically for prehospital clinicians engaging with the feedback survey.
Now fully embedded within the Bristol Royal Hospital for Children’s Emergency Department, the project continues to foster collaborative educational opportunities between paediatric emergency teams and our prehospital colleagues, ultimately supporting safer, more confident care for children across the region.
Do you feel that your local paediatric emergency department would benefit from a similar project?
We have also created a ‘how-to’ guide article on the development of this project – check it out here.
References
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