Non-conveyance of patients: Challenges to decision-making in emergency care

Abstract

Background: It has been suggested that emergency care providers’ decision-making competence should be strengthened regarding whether or not to transport the patient. This qualitative study describes challenges related to non-conveyance situations from emergency care providers’ perspective. Methods: Data were collected by a questionnaire from emergency care providers of a hospital district in Finland in 2014. Responses to open questions were analyzed using inductive content analysis to examine the difficulty of non-conveyance decisions, reasons for non-conveyance and challenges related to the non-conveyance decision after immediate care. Results: The majority (70%) of care providers did not experienced difficulty in making non-conveyance decisions, although those working in basic emergence care found decision-making slightly more challenging than workers in advanced emergency care. Care providers’ reasons for not transporting patients were most commonly connected with their assessment of care needs and the conclusion that no hospital care was required. Other reasons involved treating the patient on site, psychosocial reasons and not seeing the patient as an emergency care client. Difficulty of reaching mutual understanding with patients was considered the greatest challenge. Other challenges included worrying about the patient’s coping at home and problems in inter-professional co-operation, related to hurry and the concern that doctors did not always document requests for care instructions. Conclusions: The results suggest that care providers’ skills in assessing care needs and making decisions based on assessments are a decisive factor in non-conveyance situations. Reaching a mutual understanding with the patient is the greatest challenge.