Paramedic to general practitioner referral pathways within Australian jurisdictional ambulance clinical practice guidelines: A document analysis

Objectives: We aimed to compare the prevalence and clarity of paramedic to general practitioner (GP) referral pathways among clinical practice guidelines (CPGs) of Australian jurisdictional ambulance services (JASs). Methods: We completed a document analysis on all publicly available Australian JAS CPGs that were accessed online during 2024. We appraised CPGs according to the AGREE II Domain 4: Clarity of Presentation criteria. Results: We located 711 CPGs across the eight Australian JASs, of which 109 (15%) referenced a pathway to GP referral. Overall, 5.5% (n = 6/109) of CPGs met all the AGREE II Domain 4 criteria and considerations. The items most frequently satisfied across CPGs were (i) 'specific recommendations are appropriately selected and reflect the key messages of the guideline' and (ii) 'specific recommendations are grouped together in one section', both of which were met in 96% (105/109) of CPGs. The item least often satisfied was 'uncertainty in the interpretation and discussion of the evidence is reflected in the recommendations and explicitly stated', with only 17% (18/109) of CPGs including a discussion of evidence supporting or cautioning referral to GP pathways. Inclusion of a 'specific and unambiguous statement of the recommended action' was also consistently lacking from CPGs, with only 23% (25/109) of CPGs with referral pathways giving a specific timeframe within which the patient should be seen by a GP. Conclusion: A minority of Australian JAS CPGs include a referral to GP pathway, however, these recommendations are generally non-specific and ambiguous, limiting usability for paramedics.