Staff appeared willing to admit errors in a psychologically safe environment. Barriers to reporting are in line with international evidence. Time constraints prevented achievement of thematic saturation. Further study is warranted.
<p><strong>Introduction </strong></p><p>When a member of the public calls for an ambulance through the 999/112 system, the only permitted course of action for the responding National Ambulance Service (NAS) staff is to convey the patient to an emergency department. Regardless of the clinical level, NAS staff do not have the authority or scope of practice to discharge the patient from the scene or make any other arrangements for the treatment of that person(1). The patient, meeting certain criteria, can refuse treatment or transport (RTT) of their own volition(1). Mortality rates for non-conveyed patients vary from 0.2%-3.5% within 24hours and are twice those of patients discharged from an emergency department(2, 3). In 2017, the refusal to travel rate in Ireland jumped from 7-8% of calls (2012-2014) to a national average of 11.3% (24,735) of total AS1 calls(4). Although this level of non-conveyance would still be below international norms the rate of increase was concerning(3).</p><p><strong>Aim.</strong></p><p>A quality improvement initiative necessitated identification of baseline RTT information.</p><p><strong>Methods</strong></p><p>Retrospective data collection was conducted on all calls closed with a ‘refusal to travel’ or ‘refusal of treatment’ occurring between 1st Jan 2017 and 9<sup>th</sup> Nov 2017 and was gathered from the National Emergency Operations Centre (NEOC).</p><p><strong>Results</strong></p><p>The top three dispatch classification that resulted in RTT were falls, unconsciousness or near fainting, and generally unwell patients. This was followed by chest pain, seizures, traffic incidents and breathing problems. It was noted that the time at which RTT calls occurred peaked nationally between 2000 and 2059. In the Southern area, peak RTT occurred between 2000-2059h and 0000-0100. 33.6% of RTT calls in the Southern Area were designated as Delta calls. This designation requires an advanced life support and a blue light response and is the call level with the second highest acuity below an Echo call, the designation for Cardiac or Respiratory arrest.</p><p><strong>Conclusions</strong></p><p>The NAS specifically utilises a risk adverse triage system. Examination of dispatch priorities may be warranted. The peak close of RTT calls between 2000-2059 may align with a shift changeover at 2000. Further study is required.</p>
<p><strong>Introduction</strong></p><p>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.</p><p><strong>Aim</strong></p><p>For patients who RTT, to establish a baseline quality of information collected and recorded on a Patient Care Report.</p><p><strong>Methods</strong></p><p>All NAS incidents closed with a refusal of treatment or transport, from 1<sup>st</sup> Jan 2017 to 9<sup>th</sup> 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.</p><p><strong>Results</strong></p><p>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.</p><p><strong>Conclusion</strong></p><p>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.</p>
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