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Ambulance staff and end-of-life hospital admissions: A qualitative interview study.

Published version
Peer-reviewed

Type

Article

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Authors

Kelly, Michael P 
Prothero, Larissa 
Barclay, Stephen 

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 staff in facilitating transfer, are under-explored. AIM: To understand the role of ambulance staff in the admission to hospital of patients close to the end of life. DESIGN: Qualitative interviews, using particular patient cases as a basis for discussion, analysed thematically. PARTICIPANTS/SETTING: Ambulance staff ( n = 6) and other healthcare staff (total staff n = 30), involved in the transfer of patients (the case-patients) aged more than 65 years to a large English hospital who died within 3 days of admission with either cancer, chronic obstructive pulmonary disease or dementia. RESULTS: Ambulance interviewees 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 particularly out-of-hours, limited available patient information and service emphasis on emergency care. CONCLUSION: Ambulance interviewees 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.

Description

Keywords

Hospitals, allied health personnel, ambulances, interviews, palliative care, patient admissions, Ambulances, Hospitalization, Humans, Interviews as Topic, Qualitative Research, Retrospective Studies, Terminal Care

Journal Title

Palliat Med

Conference Name

Journal ISSN

0269-2163
1477-030X

Volume Title

32

Publisher

SAGE Publications
Sponsorship
National Institute for Health Research (NIHR) (via Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) (unknown)
Marie Curie Cancer Care (unknown)