PP39 Are our ambulance services effective and efficient? Exploration of ambulance non-conveyance: an investigation into organisational variance

<h3>Background</h3> Over the past 20 years, academic and professional papers have identified unwarranted variance in the ambulance service. The aim of this study was to investigate factors and practices which could explain and if necessary, reduce the variance in non-conveyance between ambulance services. The objectives were: Identify different types of non-conveyance in ambulance services; explore variation of non-conveyance between English ambulance services; understand the reasons for variation in non-conveyance from the experience and perceptions of ambulance service managers, clinicians and control room staff in two ambulance trusts; investigate the application of a quality framework, to understand the impact of variance on quality in non-conveyance, in two ambulance trusts; create a framework to identify variation and develop service delivery models to maximise Hear &amp; Treat and See &amp; Treat. <h3>Methods</h3> This research takes an in-depth case study approach to highlight variance in the context of performance and quality. Initially, Ambulance Quality Indicators (AQI’s) were analysed across the reference period to highlight the variance between trusts in non-conveyance. The results of this were used to create the research questions which would be answered by 27 participants, from varying roles in two ambulance services, who took part in semi-structured interviews or focus groups. A thematic analysis was undertaken on the transcripts using the Six Domains of Healthcare (IoM, 2001) excellence model, which was chosen following a review of various models and frameworks. The results of the analysis were used to create operational models, which if implemented could maximise non-conveyance. <h3>Results</h3> Performance and quality appear to be very closely linked in this setting, with the terms crossing over. It can be argued that Ambulance Quality Indicators are performance targets. There was variation in strategies used by ambulance trusts to reduce conveyance to the ED, sometimes influenced by external factors. Patient centred care was at the heart of these strategies, but the effectiveness and efficiency of strategies was variable. Improvement models were created from those strategies which delivered quality, based on the context of the quality model. <h3>Conclusion</h3> There is currently a postcode lottery as to the way in which a 999 call is dealt with across the country. Some of the strategies in place are effective and efficient, but others are not. The wider NHS system needs to offer a more consistent approach to alternative pathways, supporting the ambulance service to safely reduce conveyance to the ED. Ambulance services should review their current non-conveyance strategy for effectiveness and efficiency and share best practice. There are opportunities to improve the quality of non-conveyance, but this may require changes to current emergency and urgent care practices.