Barriers and facilitators to paramedics use of referral pathways as alternatives to emergency department presentation: A scoping review

Abstract

Background An increasing proportion of patients attended by paramedics are more suitable for referral to health and social services in the community rather than attendance at hospital emergency departments. Despite the growing number of referral pathways available to paramedics, they often remain underused. Aims To describe the depth of literature, synthesise data, and to provide an enhanced understanding of the barriers and facilitators that impact paramedics’ use of referral pathways. Methods A scoping review was performed by applying the Joanna Briggs Institute (JBI) methodology. The search strategy was translated and conducted in five databases: CINAHL Complete, MEDLINE Complete, APA PsycInfo from the EBSCOhost interface, Web of Science Core Collection from the Clarivate Interface and Scopus. Results Thirty-five articles, mostly of qualitative design, from six countries were included. Key barriers included lack of access to pathways, fear of consequences, inability to access patient records, and paramedic role perception intersecting with perceived time pressures. Core facilitators included enhanced paramedic education for non-emergency presentations, positive rather than punitive feedback, and improved satisfaction from being empowered to provide person-centred care. Conclusions To improve use of referral pathways, emergency medical services and local health systems need to consider collaboration on referral processes, increase the number of pathways, provide paramedics education on primary and urgent care presentations, and shift paramedic culture. Due to the heterogeneity of studies and settings, to inform improved referral processes, further investigation is required at local system level.