Decision-making processes when paramedics refer patients away from hospital: a scoping review.

ABSTRACT Title: Decision-making processes when paramedics refer patients away from hospital: a scoping review. Background: Paramedic practice faces increasing service demand with decision-making and referral pathways needing to change. Patients with low acuity clinical presentations do not necessarily require ambulance transport to an emergency department, and previous studies show alternative referral pathways can be effective, safe and efficient. Decision-making processes within the context of referring patients needs to be examined. Objectives: To examine the literature related to paramedic decision-making when referring patients to alternative care services, instead of transporting to hospital. Methods: In this scoping review, the literature between 2005 and 2015 of service providers was examined. Key search terms were developed to search five databases and Internet search engines. Results: Four studies were specifically related to decision-making. Research into the broader topic of paramedics referring patients to alternative medical services other than hospital emergency departments were located, and thirteen relevant studies were included in this review. Conclusions: Key factors including clinical experience, education, protocol use, referral processes, and holistic healthcare approaches all influence decision-making of paramedics when referring patients away from hospital. Further research into these factors is required to better understand how they influence and interact with each other