Exploring variation in how ambulance services address non-conveyance: a qualitative interview study.

Area of Science:

• Emergency medical services research
• Healthcare management
• Qualitative health research

Background:

• Significant variation exists in non-conveyance rates among ambulance services in England.
• Non-conveyance, including telephone advice and discharge at scene, is a critical aspect of emergency care efficiency.

Purpose of the Study:

• To explore the reasons behind the variation in how ambulance services in England manage non-conveyance.
• To understand the organizational and systemic factors influencing non-conveyance decisions for patients receiving telephone advice or discharged at the scene.

Main Methods:

• A qualitative interview study was conducted with 49 participants from ten large regional ambulance services in England.
• Interviews included managers, paramedics, and healthcare commissioners, utilizing a semistructured telephone interview approach.

Main Results:

• Organizational culture, shaped by senior management's perception of non-conveyance (opportunity vs. risk), influences its adoption.
• Workforce configuration, training, and valuation, alongside external health and social care system factors (service availability, collaboration, complexity), significantly impact non-conveyance strategies.
• Organizational stability affects the capacity for innovation in increasing non-conveyance rates.

Conclusions:

• Factors both internal and external to ambulance services contribute to variations in non-conveyance rates.
• The findings provide a basis for quantitative analysis to identify specific factors driving these rate differences across English ambulance services.