Patients’ experiences of non-conveyance following an Australian ambulance service paramedic response: A constructivist grounded theory exploration

Abstract

Understanding patient experience is associated with quality, safe, and effective healthcare. However, there is a scarcity of knowledge explaining how patients experience non-conveyance, a setting where individuals receive unscheduled ambulance service response and paramedic-led care that results in a decision to not attend a hospital emergency department (ED). This research project aimed to investigate patients’ experiences of non-conveyance within an Australian ambulance service setting. Constructivist Grounded Theory methods were used to generate and analyse data from in-depth, semi-structured interviews with 21 participants who received paramedic-led healthcare from an Australian ambulance service between August 2020 and October 2021 that resulted in non-conveyance. A substantive theory centred on ‘Restoring self-efficacy’ was generated. It comprises three categorical concepts and their interconnected relationships, explaining how patients experience non-conveyance. ‘Losing independence’ conceptualises how a precipitating event forces patients to realise their circumstantial vulnerabilities, motivating action to seek support that leads to ambulance service response. ‘Restoring self-confidence’ emerged as the core concept, central to overall experience and a key influence on patients navigating the non-conveyance decision. When patients perceive that they have received professionally thorough and compassionate healthcare from paramedics, they form a trusting partnership resulting in the interpretation that their circumstances do not require conveyance to ED. With this reconstructed perspective, patients demonstrate increased ability for ‘Self-management’, by continuing to cope with their circumstances on their own after the episode of care. This paper provides a theoretical model for understanding how patients experience non-conveyance. Experience is influenced by dynamic, complex factors associated with restoring self-efficacy in relation to managing a health topic of interest. Restoration of self-efficacy was influenced by the patients’ interpretation of their interactions with paramedics. Future research may consider investigating the impacts of applying this knowledge to paramedic education and practice, and to quality indicators surrounding non-conveyance situations.

Down with falls! Paramedicine scope regarding falls amongst older adults in rural and remote communities: A scoping review

“…Nonconveyance has been found to also potentially be a positive experience for a patient through the restoration of self-efficacy following a loss of independence to manage their individual circumstances. 46 Empowering standard care paramedics to increase the nonconveyance rate will have benefits on addressing worsening hospital ramping within Australia alongside increased response times for the communities that they serve.…”

“…Specialist paramedics have already demonstrated a reduction in overall patient contact time due to high nonconveyance rates, 22 and as such there is significant potential to increase the scope of practice of standard care paramedics to offer greater levels of care. Nonconveyance has been found to also potentially be a positive experience for a patient through the restoration of self‐efficacy following a loss of independence to manage their individual circumstances 46 . Empowering standard care paramedics to increase the nonconveyance rate will have benefits on addressing worsening hospital ramping within Australia alongside increased response times for the communities that they serve.…”

Factors influencing non-conveyance care encounters in the ambulance service, registered nurses experiences - a qualitative study

“…It is also shown that non-conveyed patients have a risk of being exposed to adverse events [ 3 , 10 , 27 , 28 ] and the non-conveyed patients often seek medical care within 72 h after assessment made by ambulance clinicians [ 29 ]. The patients’ experiences of being non-conveyed are described as ‘complex and versatile’ [ 30 ], satisfying by being empowered in the decision-making, or as negative experiences when concerns were not confirmed by the ambulance clinician [ 31 , 32 ].…”