Understanding patient non-transport decision theories in the pre-hospital setting: a narrative review

Hassan Farhat, Kawther El Aifa, Guillaume Alinier, Abdulqadir J. Nashwan, Padarath Gangaram, Moncef Khadhraoui, Loua Al Shaikh, Imed Gargouri, James Laughton

Research output: Contribution to journalReview articlepeer-review

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In pre-hospital emergency care, decisions regarding patient non-conveyance emerged as significant determinants of healthcare outcomes and resource utilization. These complex decisions became integral to the progress of emergency medical services, thus warranting an evolving exploration within the medical discourse.

Objectives and methods
This narrative review aimed to synthesize and critically evaluate various theoretical stances on patient non-conveyance in the pre-hospital emergency. The focus on studies published between January 2012 and August 2022 was intentional to capture contemporary practices and insights. PubMed and Google Scholar served as the primary databases for the investigation, while the AL-Rayyan® software facilitated a thorough screening process.

Results and discussion
Twenty-nine studies—encompassing articles, books, and theses—were discovered through our search, each presenting unique perspectives on patient non-transport, thus highlighting its criticality as a healthcare concern. Predominant factors influencing non-transport decisions were classified into patient-initiated refusals (PIR), clinician-initiated decisions (CID), and dispatcher-initiated decisions (DID).

The issue of patient non-conveyance to hospitals continues to pose a crucial challenge to the seamless operation of emergency healthcare systems, warranting increased attention from various healthcare entities. To comprehend and pinpoint potential areas of improvement, a comprehensive analysis of pre-hospital non-transport events is imperative. A well-informed, strategic approach could prevent resource waste while ensuring patients receive the required and definitive care.
Original languageEnglish
Article number69
Pages (from-to)1-15
Number of pages15
JournalInternational Journal of Emergency Medicine
Issue number1
Early online date11 Oct 2023
Publication statusPublished - 11 Oct 2023


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