Australian paramedics’ perceptions of reasonable overtime: a Delphi study

Background: Paramedics frequently incur reasonable overtime (RO) due to factors such as staffing, patient acuity and transport durations. Considering the risks associated with extended work hours, understanding paramedics’ opinions of reasonable and unreasonable overtime is vital for safe workforce management. The current study aimed to gain consensus on operational paramedics’ perception of conditions that are reasonable and unreasonable for overtime. Methods: The Delphi methodology comprised three iterative survey rounds completed by experienced paramedics working in metropolitan areas of Australia. In Round 1, participants gave a free-text definition of RO and voted on the degree to which a predetermined list of RO-related conditions were reasonable. Free-text responses underwent a content analysis to determine additional RO-related conditions based on the definitions of RO provided by participants. These conditions were then combined with the predetermined list of RO conditions and voted on by participants in Round 2 and 3. Results: Out of 189 initial participants, 144 completed Round 2 (76.2% response rate) and 128 completed Round 3 (88.9% response rate). Consensus (≥ 80% agreement) was achieved for 50% (n = 17) of the RO-related conditions. Nearly all paramedics agreed that overtime was reasonable for time-critical emergencies where there is an expected detrimental effect to a patient without a paramedic’s attendance (96%), whereas nearly all paramedics agreed that RO to ‘clear the board/pending queue’ was unreasonable (99%). Conclusions: Paramedics reached consensus on four reasonable and thirteen unreasonable conditions for RO, resulting in the creation of the first set of consensus-based considerations for RO from the perspective of operational paramedics in Australia. These findings provide important insights into how paramedics perceive RO. Future research examining the proposed considerations for RO is needed to determine their feasibility and acceptability by ambulance services and other paramedics, and their potential effectiveness in this industry for workforce planning.