Ambulance practitioners and end-of-life hospital admissions: an interview study

06 Jun 2018

Abstract Background: Hospital admissions for end-of-life patients, particularly those who die shortly after being admitted, are recognised to be an international policy problem. How patients come to be transferred to hospital for care, and the central role of decisions made by ambulance practitioners in facilitating transfer, are under-explored. Aim: To understand the role of ambulance practitioners in the admission to hospital of patients close to the end of life. Design: Case study interviews, analysed thematically. Participants/Setting: Ambulance practitioners (n=6) and other healthcare staff (n=33), involved in the transfer of patients (case-patients) aged over 65 years to a large English hospital who died within three days of admission with either cancer, chronic obstructive pulmonary disease, or dementia. Results: Ambulance practitioners were broadly positive about enabling people to die at home, provided they could be sure that they would not benefit from treatment available in hospital. Barriers for non-conveyance included difficulties arranging care for case-patients, particularly out-of-hours, limited available patient information, and service emphasis on emergency care. Conclusion: Ambulance practitioners fulfilled an important role in the admission of end-of-life patients to hospital, frequently having to decide whether to leave a patient at home or to instigate transfer to hospital. Their difficulty in facilitating non-hospital care at the end of life challenges the negative view of near end-of-life hospital admissions as failures. Hospital provision was sought for dying patients in need of care which was inaccessible in the community.