Pathway enhancement for the referral of non-conveyed patients with incidental findings encountered by ambulance clinicians (PERIFERAL)

Research question: How can ambulance clinicians improve the identification, referral and management of incidental findings in non-conveyed patients to enhance early detection and intervention for serious health conditions? Background: In 2023/24, nearly one-third of emergency ambulance calls in England did not result in hospital conveyance. Approximately half of these patients had incidental findings, such as hypertension, atrial fibrillation or hyperglycaemia, which were unrelated to the initial emergency call but are likely to benefit from investigation or treatment. However, the current approach to these findings is inconsistent, with limited communication between paramedics and GPs. This means that opportunities for early intervention and prevention of conditions like strokes or heart attacks are missed, so there is a clear need for standardised referral processes to improve patient outcomes and reduce healthcare system strain. Aims and objectives: The PERIFERAL study aims to understand how incidental findings identified by ambulance clinicians should be optimally managed. The specific objectives are: To define and identify incidental findings during ambulance attendance, describe the characteristics of affected patients, and explore whether patient characteristics are associated with identifying and acting upon these findings. To evaluate current incidental findings referral practices across UK ambulance services. To identify barriers and facilitators to effective management through stakeholder interviews. To develop and refine a standardised referral pathway for incidental findings in ambulance services. Methods: This 24-month mixed-methods study consists of four work packages, aligned with the development phase of the MRC complex development intervention framework: WP1: Understand the characteristics and referral patterns of non-conveyed ambulance service patients with incidental findings using linked ambulance service and primary and secondary care data. WP2: Telephone survey of all 13 UK ambulance services to map existing referral pathways and understand their effectiveness. WP3: Qualitative interviews with 40-60 patients, paramedics and primary care staff across four case study ambulance services to explore barriers and facilitators to managing incidental findings. WP4: Development and iterative refinement of a referral pathway, with feedback from four stakeholder focus groups, each with up to 8 participants, to assess feasibility and acceptability. Timelines for delivery: Months 0–4: Ethics and governance approvals, dataset access. Months 5–7: Quantitative data analysis (WP1) and telephone survey (WP2). Months 8–14: Data analysis (WP1) and stakeholder interviews (WP3). Months 15–20: Pathway development, focus groups and final refinement (WP4). Months 21-24: Dissemination. Anticipated impact and dissemination: This study will produce a standardised referral pathway for ambulance clinicians to manage incidental findings, improving early detection and intervention for conditions like hypertension, atrial fibrillation, diabetes and chronic obstructive pulmonary disease. Enhanced referral processes will reduce missed diagnoses, prevent long-term health complications and align with public health priorities. Findings will be disseminated through academic publications, social media, conferences, and collaborations with key healthcare organisations, such as the College of Paramedics, Association of Ambulance Chief Executives, the Royal College of General Practitioners and NHS England. The project s outputs will contribute to more efficient healthcare resource utilisation, benefiting patients and the wider healthcare system.