Decisions on and variations in conveyance to emergency departments: an evaluation
Journal of Paramedic Practice · 2026-05-02 · Observational study
Abstract
In recent years, ambulance services have shifted their focus from default emergency department (ED) conveyance towards care closer to home; however, variation in non-conveyance rates persists. This mixed-methods service evaluation surveyed 210 and interviewed 25 operational ambulance clinicians to explore factors influencing non-conveyance. Thematic analysis identified four themes: organisational support and culture; decision support tools; the evolving scope of practice and education; and access to care pathways. While 67% of respondents reported consistently using clinical decision support tools, a perceived lack of organisational backing, fear of litigation, inconsistent pathway availability and limited feedback often drove defensive conveyance. The findings highlight the need for improved feedback, strengthened supervision and clearer referral guidance. The study also emphasises the importance of cultural change, targeted workforce development and increased investment in integrated care. Nine priority areas were identified to support the authors' ambulance trust in reducing unnecessary conveyance and enhance consistency in patient care.
Abstract © the authors or publisher, via OpenAlex. Reuse and removal
Tags
Decision support tools · Implementation
Related articles
- Ambulance clinicians' non-conveyance decisions: a review of influencing factors (Journal of Paramedic Practice, 2026)
- Developing a decision support system for geriatric patients in prehospital care. (Eur J Emerg Med, 2013)
- Development of the PriCARE classification for potentially preventable emergency department visits by ambulance: a RAND/UCLA modified Delphi study protocol. (BMJ Open, 2021)
- Can a poison center overdose guideline safely reduce pediatric emergency department visits for unintentional β-blocker ingestions? (Am J Ther, 2012)
- Clinical decision support system in emergency telephone triage: A scoping review of technical design, implementation and evaluation. (Int J Med Inform, 2024)
- Using computer decision support systems in NHS emergency and urgent care: ethnographic study using normalisation process theory. (BMC Health Serv Res, 2013)