Ambulance clinicians' non-conveyance decisions: a review of influencing factors

Emergency department overcrowding in the UK is exacerbated by unnecessary ambulance conveyances, driven by rising demand from an ageing population, increasing mental health issues, limited primary care access and primary care workforce shortages. Initiatives such as hear and treat and alternative care pathways have reduced avoidable conveyances; however, ensuring safety remains a challenge for ambulance clinicians. This scoping review identified three key themes influencing non-conveyance decisions: organisational culture and professional development; clinical decision support systems; and care pathways and patient expectations. Improving non-conveyance requires the linking of emergency department and ambulance data systems to enable supervision feedback, targeted training and organisational support to foster psychological safety. Clinical decision tools aid decision-making but inconsistent community services, external pressures and low guideline adherence hinder the safe implementation of alternative care. Addressing these issues requires better integrated care coordination and a collaborative, system-wide approach to support ambulance clinicians in making safe, effective non-conveyance decisions.