Non-Conveyance and Discharge to Home

Overview#

Not every ambulance response ends at a hospital. Many encounters end with a clinically-led decision to leave the patient at home, with safety-netting advice, a letter to the GP, and a follow-up plan. That decision needs to be captured properly, with capacity, witness, and signature, all on the responder mobile.

The Non-Conveyance and Discharge module records refusal of treatment, refusal of conveyance, and clinically-led discharge to home as a final disposition on the encounter. It binds the capacity assessment outcome, the safety-netting plan, the GP letter, and the patient's signed acknowledgement to the canonical incident so the rationale is reviewable later if circumstances change.

Last Reviewed: 2026-05-05 Last Updated: 2026-05-05

Key Features#

• Capacity Assessment Capture: Record the capacity assessment outcome alongside the clinical rationale at the point the non-conveyance decision is made.

• Refusal of Treatment and Conveyance: Distinguish patient-led refusal from clinically-led discharge so the encounter record reflects what actually happened on scene.

• Safety-Netting Plan: Attach the advice given to the patient (red flags, when to re-contact, expected course) as a structured plan rather than free text alone.

• GP Letter Generation: Produce a discharge document for the patient's primary care team directly from the encounter without re-keying clinical content.

• Patient Signature on Mobile: Capture the patient's signed acknowledgement on the responder device, with a recorded witness where required.

• Follow-Up Booking: Arrange the next contact with the patient's primary care team as part of the disposition rather than as a separate task.

• Incident-Bound Disposition: Bind the non-conveyance outcome, signed document, and capacity assessment to the canonical incident so the decision is reviewable in context.

Use Cases#

• Patient Refuses Conveyance With Capacity: A patient with documented capacity declines transport; refusal, capacity outcome, witness, and signature are recorded on the responder mobile.

• Clinically-Led Discharge to Home: After assessment the clinician determines transport is not required; the safety-netting plan and GP letter are produced from the encounter.

• Discharge With GP Follow-Up: A discharge letter is sent to the patient's GP through HSE HealthLink and a follow-up contact is booked with the primary care team.

• Re-Contact Within 48 Hours: A subsequent call from the same patient is linked back to the original disposition so the prior rationale is visible to the next responder.

• Audit and Clinical Governance Review: A reviewer can see the rationale, capacity outcome, safety-netting plan, and signed acknowledgement against the original incident.

Integration#

• Argus EPCR Non-Conveyance Service: The non-conveyance domain in argus_middleware records the disposition, rationale, and capacity outcome against the encounter.

• Discharge Documentation Service: The discharge document builder produces the GP letter and structured safety-netting plan from the encounter content.

• Patient Signature Capture: The signatures service records the patient's signed acknowledgement and the witness where applicable.

• HSE HealthLink Outbound: The national services layer sends the discharge letter to the patient's GP using HL7 v2.4 messaging through HSE HealthLink.

• Responder Mobile Screens: The non-conveyance and discharge document screens on the responder mobile app drive the on-scene capture flow.

• Incident Correlation for Follow-Up: A re-contact within 48 hours creates a child incident linked back via incident_correlations.correlation_kind='followup' so the original disposition stays in context.

Open Standards#

• HL7 FHIR R4 Consent: refusal of treatment and refusal of conveyance are represented using the standard consent resource pattern.

• HL7 FHIR R4 DocumentReference: the generated GP letter is exposed as a standard document reference resource.

• HL7 FHIR R4 CarePlan: the safety-netting plan is structured as a care plan rather than only free-text instructions.

• HL7 v2.4: outbound discharge messaging to GPs uses the version expected by HSE HealthLink.

• SNOMED CT: refusal codes and capacity assessment outcomes are recorded against the standard clinical terminology.

• ICD-10: encounter outcome coding uses the standard diagnostic classification.

• PHECC NCG: non-conveyance practice aligns with the Irish Pre-Hospital Emergency Care Council National Clinical Guidelines.

• JRCALC 2024: capacity-assessment guidance follows the Joint Royal Colleges Ambulance Liaison Committee 2024 guidelines.

• Assisted Decision-Making (Capacity) Act 2015: capacity assessment is recorded against the Irish legal framework for capacity decisions.

• CloudEvents 1.0: disposition and discharge events are emitted as argus.disposition.non_conveyance and argus.disposition.discharge_signed for downstream consumers.