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

Eamonn Byrne, Sasha Selby, Paul Gallen, Alan Watts

DOI: http://dx.doi.org/10.32378/ijp.v3i2.145

Abstract

Introduction

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.

Aim

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

Methods

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.

Results

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.

Conclusion

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.


Keywords

paramedic; ambulance; transport; non-conveyance

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References

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: http://www.nationalambulanceservice.ie/Clinical%20Care/Clinical-Directives-Advisories/Refusal-of-Care-NAS-Medical-Directorate-Interim-Guidance-for-Staff.pdf.

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].



DOI: http://dx.doi.org/10.32378/ijp.v3i2.145

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