Background In England, approximately 10% of patients who contact the ambulance service receive clinical telephone advice rather than a face-to-face ambulance response. This analysis identifies whether patients who receive ambulance telephone advice to attend ED comply with this advice and explores the appropriateness of subsequent ED attendances.

Methods Ambulance CAD, HES (A&E/inpatient) was linked for 2521 hear and treat callers as part of the PhOEBE study. For data linking reasons, the sample includes only patients who had other experiences of contacting the ambulance service. Additional information from the ambulance telephone advice call was linked to the PhOEBE data using the CAD ID and date/time of call. Appropriateness of ED attendances was determined using a method that assesses whether patients receive investigations/treatments in the ED and that appropriateness denotes care that is proportionate to need.

Results This analysis is based on 1892/2521 (75%) cases which have both ambulance telephone advice and ED attendance data, as some ambulance advice information was unavailable. 522 patients (28%) attended ED within 3 days of the ambulance call. Of these, 235 were advised by the ambulance service to attend ED. The remaining 287 patients were advised to seek other care, with most advised to seek GP care (n=180). 81.6% of ED attendances were assessed as appropriate. 129 patients were advised to attend ED and did not attend within 3 days.

Conclusions Ambulance telephone advice information was successfully linked to other health-service information. Patients included in this analysis are older and more likely to be sicker than the general hear and treat population, as all had other experiences of using the ambulance service. Most ED attendances were appropriate. Some patients did not comply with advice to attend ED. More research is required to investigate the factors around compliance with advice to attend ED and to find out what happens to these patients.