Paramedic perceptions of conveying patients to an emergency department who were suitable for primary care: a cross-sectional survey.

Background: Ambulance callouts and conveyances continue to increase disproportionately to population growth. This is largely driven by low- and medium-acuity patients who do not require ambulance management. We aimed to estimate the proportion of patients paramedics have conveyed to an emergency department (ED) via ambulance whom they considered suitable for primary care, and understand the barriers that contributed to these decisions. Methods: A cross-sectional survey of registered paramedics in Victoria, Australia, was undertaken using an online questionnaire during 2022. Responses are presented using descriptive statistics, and logistic regression was used to identify associations between paramedic characteristics and barriers influencing primary care pathway referral. Results: A total of 367 responses were received. Of these, 70% of paramedics reported that at least half of the patients they conveyed to an ED were suitable for a primary care pathway. Paramedics reported high levels of confidence and support for primary care pathways in lieu of transport, however this had no correlation with their self-reported practice. The most common barrier to primary care pathway referral was limited access to a suitable primary care pathway (68%) followed by fear of an internal complaint, litigation or organisational pressure to convey patients to an ED (66%). Paramedics regarded themselves as more supportive of primary care pathway referral than those around them, including their peers, mentors, employers and university. They also reported that the COVID-19 pandemic had increased their personal support for primary care pathways, as well as organisational support from their employer, without corresponding increase in the broader medical and public communities. In fact, paramedics reported the COVID-19 pandemic had decreased support from the public and patients to refer patients to primary care pathways, and 57% of paramedics reported conveying a patient that had declined their primary care referral in the past week. Conclusions: Paramedics frequently convey to an ED patients who they believe are appropriate for a primary care pathway. Paramedics face practical barriers such as a lack of available primary care providers and perceived lack of cultural support that contribute to this practice. Paramedics are increasingly attending low- and medium-acuity patients, and paramedics in our survey self-reported that at least half of the patients they conveyed to an ED were appropriate for a primary care pathway. Notable barriers to primary care referrals included limited access to suitable primary care and fear of organisational repercussions or litigation following non-conveyance. This research has important implications for the educational, practical and organisational support given to paramedics regarding primary care diversion for suitable patients. [ABSTRACT FROM AUTHOR]