HSE audit: Some patients are not being made aware of risk of not attending hospital

Stock picture: Denis Minihane

A HSE audit has expressed concern that paramedics might not be explaining the consequences of not attending hospital to patients who decline to get in an ambulance.

A report by the HSE found 45% of electronic patient records completed by members of the National Ambulance Service (NAS) contained no evidence to suggest the potential risks of not attending hospital were explained to patients.

The audit involved a review of four NAS stations — Cavan, Dooradoyle, Ennis, and Ballyshannon — at the end of 2020.

It found patients were recorded at two stations — Ennis and Ballyshannon — as having been transported to a specific hospital even though the patient had declined to get in an ambulance.

The report also identified what it claimed were “multiple inconsistencies” in how ambulance crews completed electronic patient records.

Only 60% of records across the four NAS stations were found to be in compliance with guidelines on the treatment of patients who refuse to be transported to hospital.

The report noted that NAS management was not confident that all cases where a patient had refused transport by ambulance to hospital had been notified to a paramedic supervisor as required by ambulance crews.

Under existing guidelines, no NAS employee has the authority to decide a patient does not require transport to hospital.

All patients must be transported to a hospital unless they decline treatment and transport and show they have the capacity to make such a decision.

The audit report said the electronic patient record might by the only record the HSE has of an interaction with a patient.

“Failure to record all cases of a PNT [patient non-transport] in a manner consistent with the guideline could become a patient safety risk and leave the HSE exposed in the event of subsequent legal action,” it observed.

Auditors also found no regular formal meetings took place between paramedics and their supervisors or between supervisors and resource managers at all four locations.

The NAS, which employs over 2,000 staff across 104 locations, responds to over 300,000 callouts each year on average.

The HSE said the audit was carried out at the request of the director of the NAS.

It recommended that assurance should be sought from the NAS that arrangements are in place such that all cases of patients refusing to be transported by ambulance to hospital are being recorded in compliance with guidelines and that they are followed up with a timely review by paramedic supervisors.