The research, published in BMC Health Services Research, examined Prehospital Assessment Units, or PAUs, which are paramedic-staffed units designed to strengthen acute care pathways by assessing patients before a decision is made about hospital conveyance. The model sits squarely within a broader international trend toward non-conveyance, in which emergency medical services are asked not merely to transport patients but to evaluate them at the scene, treat what can be treated, and connect people with the right level of care, which is sometimes no hospital visit at all. Sustainable implementation of such services, the Danish team argued, depends on cooperation across sectors that have historically operated in separate silos.

To capture how the model is landing on the ground, the researchers used a convergent parallel mixed-methods design, running quantitative questionnaires and qualitative focus groups simultaneously and then integrating the results. Data were collected between April and August 2024 across the emergency medical services, hospital emergency departments, general practice, and municipal acute care in the Region of Southern Denmark. The questionnaire drew on previously published and validated outcome measures, while the qualitative material was analysed using Reflexive Thematic Analysis, a technique in which researchers systematically code narratives and construct themes that interpret shared experiences rather than simply counting them.

The numbers tell a strikingly positive story. Of 231 healthcare professionals who responded to the questionnaire, a response rate of 51.7 percent, 166 were included after prespecified exclusions. On a one-to-five scale, the median score for the Acceptability of Intervention Measure was a perfect 5.00, with an interquartile range of 4.00 to 5.00, meaning that at least three quarters of respondents rated acceptability at four or above. The Intervention Appropriateness Measure yielded a median of 4.13, and the Feasibility of Intervention Measure a median of 4.25, with interquartile ranges of 4.00 to 5.00 and 3.75 to 5.00 respectively. In plain terms, the clinicians who interact with PAUs overwhelmingly regard them as acceptable, largely appropriate, and broadly workable.

Numbers alone, however, cannot explain why a service succeeds or stalls, and this is where the qualitative arm of the study earns its keep. Three focus groups involving 18 participants drawn from across the acute care spectrum captured cross-sector experiences in depth. The thematic analysis generated three themes: the contested work of patient selection, integration in acute care, and building understanding through shared narratives. Together, these themes map the social and organisational terrain on which the PAU model either flourishes or frays, revealing that a service can be well liked in principle while still generating friction at its operational edges.

The first theme, patient selection, points to what may be the model’s most consequential challenge. Deciding which patients can be safely assessed and left at home, and which genuinely need an emergency department, is inherently contested work, and the qualitative accounts suggest that boundaries around this decision are not always clear. When frontline staff in different parts of the system disagree about who belongs in a PAU’s remit, consistency suffers, and the researchers identified this variability as a negative implementation determinant, a factor that may hinder uniform delivery of the service across settings and shifts.

The second theme, integration in acute care, extends that concern to the institutional level. A prehospital assessment unit does not operate in a vacuum; its value depends on how smoothly it slots into emergency departments, general practice, and municipal acute care. The study found evidence of role negotiation, with professionals working out where PAU staff fit within established hierarchies and workflows. Accounts of this negotiation, alongside variability in feasibility scores, revealed further negative determinants rooted in contextual factors and unclear boundaries between services. These are not failures of the model so much as growing pains of a system learning to share responsibility for acutely ill patients across traditional dividing lines.

The third theme, however, offers a genuine cause for optimism. Shared narratives, the stories professionals tell each other about the service, emerged as a powerful engine of understanding. Qualitative narratives reinforced the quantitative findings, legitimising the PAUs and highlighting their contribution across sectors. When emergency department physicians, general practitioners, municipal staff, and paramedics exchange experiences of the unit in action, abstract scepticism gives way to concrete appreciation of what the service can and cannot do. The researchers identified this cross-sector contribution and the role of shared experience as positive implementation determinants, suggesting that communication itself is an intervention worth investing in.

The methodological machinery behind these conclusions deserves attention. By using a joint display to align quantitative ratings with qualitative determinants, the researchers could check whether the numbers and the narratives told the same story, and largely they did. The high acceptability scores were corroborated by qualitative accounts that legitimised the service, while the spread in feasibility scores was echoed by focus group discussions of selection disputes and integration struggles. This convergence strengthens confidence that the findings reflect real professional experience rather than artefacts of either surveys or interviews. The study was classified as a quality assurance initiative under Danish legislation, exempt from formal ethical review, with informed consent obtained from all participants and data handling compliant with the General Data Protection Regulation.

For health systems everywhere grappling with emergency department overcrowding and ageing populations, the Danish experience carries a clear message. Paramedic-staffed prehospital assessment units can earn the trust of the clinicians around them, and that trust is measurable, with median acceptability scores at the top of the scale. But acceptance is only the first hurdle. The contested work of deciding who can be safely left at home, and the institutional work of weaving a new service into the fabric of acute care, will determine whether such models deliver consistent benefits or uneven ones. The authors conclude that healthcare professionals reported predominantly positive experiences of the PAU model, while the challenges they identified reflect contextual factors and unclear boundaries that may hinder consistent implementation. In other words, the idea has won the argument; now comes the harder task of winning the workflow.

Subject of Research: Implementation of paramedic-staffed prehospital assessment units in acute care

Article Title: Healthcare professionals’ experiences of implementing paramedic-staffed prehospital assessment units in acute care: a mixed-methods study

Article References: Healthcare professionals’ experiences of implementing paramedic-staffed prehospital assessment units in acute care: a mixed-methods study. (n.d.). https://doi.org/10.1186/s12913-026-15764-9

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15764-9

Keywords: prehospital care, paramedics, non-conveyance, emergency medical services, acute care, implementation science, mixed methods, acceptability, feasibility, patient selection, health services research, Denmark