Background Ambulance clinicians may call ahead to the ED to inform them that a critically ill or deteriorating patient is on their way (pre-alert). Pre-alerting is an important part of the care pathway for certain conditions (e.g. stroke, STEMI). However, the value of pre-alerting for other conditions is less well understood.

Methods We undertook semi-structured interviews with ambulance clinicians (n=35) from three ambulance services and ED clinicians (n=32) from 6 EDs and non-participant observation in 6 EDs (86 hours, 109 pre-alerts). Detailed observation notes and verbatim interview transcripts were imported into NVIvo and analysed thematically.

Results Pre-alert calls were key to enabling staff to appropriately prioritise patient care, with responses ranging from large multidisciplinary teams awaiting the patient’s arrival to psychological preparedness. ED staff valued this advance notice, even when they were unable to make practical changes due to lack of space in the department. ED response to pre-alert calls was related to their capacity at the time of call.

Although ED staff expressed frustration at perceived over- or inappropriate use of the pre-alert phone, there was widespread acknowledgement that under-alerting was potentially more harmful, particularly in the context of increased risk to patients due to longer wait times.

There were differences in how EDs recorded and responded to pre-alerts. A lack of training in receiving and managing pre-alert calls led to inconsistencies in how calls were taken and increased the risk of inappropriate action. ED staff valued clarity, conciseness of information and an accurate arrival time from pre-alert calls, as this enabled most effective use of limited resources.

Conclusion Pre-alerts were generally welcomed and enabled preparation and appropriate care for the most unwell patients, despite the challenges they posed to already stretched departments. They could be improved by consistency of delivery and receiving of pre-alert calls.