Ambulance staff and end-of-life hospital admissions: A qualitative interview study

Abstract

Background:Hospital admissions for end-of-life patients, particularly those who die shortly after being admitted, are recognised to be an international policy problem. How patients come to be transferred to hospital for care, and the central role of decisions made by ambulance staff in facilitating transfer, are under-explored.Aim:To understand the role of ambulance staff in the admission to hospital of patients close to the end of life.Design:Qualitative interviews, using particular patient cases as a basis for discussion, analysed thematically.Participants/setting:Ambulance staff (n = 6) and other healthcare staff (total staff n = 30), involved in the transfer of patients (the case-patients) aged more than 65 years to a large English hospital who died within 3 days of admission with either cancer, chronic obstructive pulmonary disease or dementia.Results:Ambulance interviewees were broadly positive about enabling people to die at home, provided they could be sure that they would not benefit from treatment available in hospital. Barriers for non-conveyance included difficulties arranging care particularly out-of-hours, limited available patient information and service emphasis on emergency care.Conclusion:Ambulance interviewees fulfilled an important role in the admission of end-of-life patients to hospital, frequently having to decide whether to leave a patient at home or to instigate transfer to hospital. Their difficulty in facilitating non-hospital care at the end of life challenges the negative view of near end-of-life hospital admissions as failures. Hospital provision was sought for dying patients in need of care which was inaccessible in the community.

Home care and end-of-life hospital admissions: a retrospective interview study in English primary and secondary care

“…Data were synthesised to understand both the individual case-patients’ admission, and the admissions collectively, with synthesis aided by reference to both end-of-life care and sociological literature. Extended details about the study methodology26 , 27 and related findings10 can be found elsewhere.…”

Death and dying in prehospital care: what are the experiences and issues for prehospital practitioners, families and bystanders? A scoping review

“…Few papers focused on family and significant others’ experiences, but those that did reported the lasting impact of these events. 61 68 70 77 83 84 Included papers reported on family experiences in prehospital palliative and EoLC, 61 68 83 OHCA, 70 77 resuscitation 76 and suicide. 84 Witnessing a family member die or dying was reported as having a significant effect on relatives and particularly at OHCAs, families experienced a range of emotions, including reactions of shock, vulnerability, responsibility and hopelessness.…”

“…Papers that included family members’ accounts and experiences were few and tended to focus on their interactions with HCPs, including communication and behaviours during resuscitation and cardiac events, 70 76 77 EoLC, 61 68 83 the impact of cardiac events 70 77 88 and occasionally experiences of suicide. 84 Generally, relatives reported positive interactions with PHPs, commenting on their confidence and calmness in attending scenes involving death and dying, and while some families reported more negative encounters, it suggests there may be a disconnect between PHPs’ perceptions of the care they provide and families’ experience of that care.…”

Hospice advice and rapid response service for ambulance clinicians

“…Barriers to non-conveyance of palliative care patients to hospital have been shown to include the lack of out-of-hours cover by palliative care specialists,2 difficulties arranging care particularly out of hours, limited available patient information and service emphasis on emergency care 3. One study showed that lack of access to palliative care nurses is a reason for unnecessary admissions of older patients 4…”