title: Are they really refusing to travel? A qualitative study of prehospital records.
abstract: BACKGROUND
  Refusal by the patient to travel after calling an emergency ambulance may lead to a preventable waste of scarce resources if it can be shown that an alternative more appropriate response could be employed. A greater understanding is required of the reasons behind 'refusal to travel' (RTT) in order to find appropriate solutions to address this issue. We sought to investigate the reasons why patients refuse to travel following emergency call-out in a rural county.
  
  
  METHODS
  Written records made by ambulance crews for patients (n = 397) who were not transported to hospital following an emergency call-out during October 2004 were retrospectively analysed.
  
  
  RESULTS
  Twelve main themes emerged for RTT which included non injury or minor injury, falls and recovery after treatment on scene; other themes included alternative supervision, follow-up and treatment arrangements or patients arranging their own transport. Importantly, only 8% of the sample was recorded by ambulance crews as truly refusing to travel against advice.
  
  
  CONCLUSIONS
  A system that facilitates standardised recording of RTT information including social reasons for non-transportation needs to be designed. 'Refused to travel' disclaimers need to reflect instances when crew and patient are satisfied that not going to hospital is the right outcome. These recommendations should be considered within the context of the plans for widening the role of ambulance services.
authors.affiliation: East Midlands Ambulance Service NHS Trust, Ambulance Training Centre, 4 Proctors Road, Outer Circle Road, Lincoln, UK. debbie.shaw@emas.nhs.uk
authors.forename: Deborah
authors.initials: D
authors.lastname: Shaw
authors.forename: Jane V
authors.initials: JV
authors.lastname: Dyas
authors.forename: Jo
authors.initials: J
authors.lastname: Middlemass
authors.forename: Anne
authors.initials: A
authors.lastname: Spaight
authors.forename: Maureen
authors.initials: M
authors.lastname: Briggs
authors.forename: Sarah
authors.initials: S
authors.lastname: Christopher
authors.forename: A Niroshan
authors.initials: AN
authors.lastname: Siriwardena