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.
Godley et al. (Sat,) studied this question.