Refusal to Travel in the National Ambulance Service. A Patient Care Report examination.

Eamonn Byrne, Sasha Selby, Paul Gallen, Alan Watts




Every patient has the right to refuse treatment and, or transport (RTT) to hospital (1). The National Ambulance Service (NAS) has operated under a clinical guidance document that requires an assessment of patient capacity and a baseline amount of data to be gathered on every patient to facilitate the patient making an informed decision (2,3). An increase in the rate of non-conveyance of patients and refusal to travel calls as well as an increasing number of complaints prompted a quality improvement initiative based on improving and facilitating a shared decision-making model.


For patients who RTT, to establish a baseline quality of information collected and recorded on a Patient Care Report.


All NAS incidents closed with a refusal of treatment or transport, from 1st Jan 2017 to 9th November 2017 were identified from National Emergency Operation Centre (NEOC). A random selection of 75 Patient care reports (52 Paper and 23 Electronic) were identified and reviewed. Compliance with the refusal to travel guidance document was measured.


31% of paper PCR’s reviewed were missing a complete set of vital signs. An average of 48.4 % (Median 48.4% Range 36.5% to 61.5%) were missing a complete second set of vital signs. 17.3% of combined forms were missing the patient’s chief complaint and 38.7% had no practitioner clinical impression entered. 24% had no capacity assessment completed.


Clinical information recorded by NAS staff did not meet the clinical guidance document requirements. It is impossible to assess what information was given to a patient to facilitate a shared decision-making model. The quality of NAS documentation can be improved for patients who refuse to travel.


paramedic; ambulance; transport; non-conveyance

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Holder P, Arthur AO, Thiems G, Redmon T, Thomas M, Goodloe JM, et al. Patients Refusing Prehospital Transport Are Increasingly Likely to Be Geriatric. Emerg Med Int. 2012;2012.

O'Donnell C. Medical Directorate. Guidance Document: Patient Refusal of Care. Version 1.1. 2014 [cited 2018 July 21]. Available from:

O'Donnell C. Patient Refusal of Transport Version 2.0 Revised February 2018. Naas: National Ambulance Service; 2018 [updated 2018 Feb; cited 2018 July 21].



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