Patient-centric perspectives on non-conveyance decisions following pre-hospital emergency calls: A qualitative study

Background: Patient-centered care is a foundation for high-quality healthcare delivery and is recognized by the Institute of Medicine as one of the six key elements of healthcare quality. It is fundamental to improving health outcomes, patient satisfaction, and overall healthcare system performance. In contemporary healthcare, we are encouraged to optimize our practices and deliver patient-centered care by actively seeking and analyzing patient feedback. This study explored patients’ decision to refuse transportation to a medical facility after receiving on-scene pre-hospital emergency treatment.

Methods: A qualitative analysis approach was applied using semi-structured telephone interviews with 210 patients who had requested Hamad Medical Corporation Ambulance Service pre-hospital emergency care from June 15 to August 1, 2023 and decided not to proceed with hospital conveyance. A thematic analysis with inductive coding of the open-ended feedback was performed using Nvivo® software version 12.

Results: Data saturation was achieved with 32 responses. The thematic analysis revealed five critical themes: “Rationales for using 999 emergency services”, which primarily focused on acute medical needs and the absence of alternative healthcare solutions; “Reasons for declining hospital conveyance”, which included family obligations and previous unsatisfactory encounters at the hospital; “Subsequent steps after declining hospital transportation”, which disclosed that most respondents remained at home after the intervention, while a minority sought further medical consultation through alternative means; “Service satisfaction level”, which was predominantly positive; and “Language barriers”, which highlighted specific challenges during the emergency call-taking process.

Conclusion: The study provided an understanding of the factors influencing patient decision-making in emergency medical contexts. It advocated targeted quality improvement interventions such as gender-responsive services and linguistic inclusivity. These findings highlighted the need for an integrative, patient-centered model that is attuned to the cultural and linguistic intricacies, thereby informing policy and practice to increase the efficacy of emergency medical services in Qatar.