Background Many palliative patients prefer to receive care at home rather than attend hospital (Evans et al., 2006). Most community palliative care services are unable to provide 24-hour in-person care, therefore ambulance services are often called to assess palliative patients in acute situations. Palliative ambulance management plans (AMPs) are documents created in collaboration with patients and their families. These documents assist ambulance personnel in the acute care of patients with life-limiting illness by outlining the patient’s goals of care regarding transport to hospital versus best supportive care at home, and by providing guidance on the provision of symptom management at home.

Objectives The aims of this study were to assess whether patients’ AMP goals of care regarding transport to hospital were being followed, to describe the common indications for ambulance attendances and transport to hospital in patients with AMPs, and to identify outcomes for the patients who were transported to hospital.

Method This was a retrospective study describing the use of AMPs in the Hutt Valley region, New Zealand. Patients in the Hutt Valley health district with an AMP created between January 1st and December 31st 2022 inclusive were included (table 1). Patients were followed until death or 12 months after implementation of their AMP. Data was collected from the Wellington Free Ambulance and Capital, Coast and Hutt electronic databases.

Results 111 patients were included in this study. The majority of patients (74%) had a primary diagnosis of cancer. 67 ambulance attendances were observed across 46 patients, and 40% resulted in transport to hospital (n=27). 69% of patients’ goals of care were for ‘symptom control at home’. Goals of care were followed in 76% of all ambulance attendances. Of the 27 transports to hospital, 44% were inconsistent with the patient’s goals of care (n=12). The most common reason for transport to hospital against goals of care was ‘family’s wishes’ (n=5). The most common indications for an ambulance attendance were pain (28%) and breathlessness (15%). Infection was the most common indication for transport to hospital (22%), and the most common indication for ambulance attendance in patients who were transported to hospital against their goals of care. 59% of patients transported to hospital were discharged home. Of the 5 transports to hospital that resulted in death, only one was inconsistent with the patient’s goals of care.

Discussion Although uncontrolled symptoms were the most common indications for an ambulance attendance, most of these attendances did not result in transport to hospital. AMPs provide ambulance personnel with the ability to both recognise a patient’s wishes to remain at home where possible and provide care that can enable this. It is encouraging that the majority of patients received care consistent with their goals of care. We acknowledge that these directives may be appropriately overridden in circumstances where a hospital admission is expected to be beneficial (Robinson et al., 2015), however our study suggests that these decisions may be influenced by family rather than the patient themselves. Further research into ambulance personnel perspectives on AMPs would be valuable.