Ambulance clinician referral to external providers within a locality: a clinical audit
Journal of Paramedic Practice · 2026-07-02 · Observational study
Abstract
Background: The urgent and emergency care system in England is under increasing pressure, prompting ambulance services to provide care outside emergency departments (EDs), through on-site treatment, community services and phone advice. National strategies emphasise shifting care from hospitals to community-based services to reduce avoidable conveyance and admissions. Aims: This study explored factors contributing to declined referrals from North West Ambulance Service (NWAS) patients to alternative-to-ED pathways, to inform service evaluation and quality improvement. Methods: A retrospective observational study analysed 75 declined referrals from four local services between September and December 2024. Data included patient demographics, frailty, clinical scores, ambulance clinician interventions, reasons for declined referral and final destinations. Results: Over half (51%) of patients were successfully redirected, while 25% were conveyed to ED despite meeting criteria for alternatives. Most were elderly, moderately to severely frail, and required no clinical intervention, yet conveyance remained common, especially for admissions referred by healthcare professionals. Conclusion: Incomplete documentation, fragmented pathways, limited services and risk-averse decision-making contributed to unnecessary ED conveyance, highlighting the need for improved referral systems and expanded community care.
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Tags
Implementation · Older adults · Paramedics & EMTs
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