TY - JOUR
T1 - Advanced paramedic agreement on ‘inappropriate’ emergency department attendances
T2 - Secondary data analysis from the better data, better planning study
AU - Cummins, Niamh M.
AU - Galvin, Rose
AU - Phillips, Jake S.
AU - Barry, Louise A.
AU - Byrne, Eamonn
AU - Devergie, Julian
AU - Hayes, Keith
AU - Henry, Kieran
AU - O’Connor, Chris
AU - O’Toole, Michelle
AU - Barry, Tomás
N1 - Publisher Copyright:
© The Author(s) 2026. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
PY - 2026
Y1 - 2026
N2 - Background: Expansion of paramedic roles in the community could reduce non-urgent emergency department (ED) attendances. In Ireland a knowledge gap exists regarding the development of alternative care pathways that avoid ED conveyance. The aim of this research was to explore inter-rater agreement amongst advanced paramedics (AP) about the ‘appropriateness’ of attendances to the ED in Ireland utilising data from the Better Data, Better Planning (BDBP) Study. Methods: The BDBP study was a multi-centre study investigating factors influencing ED utilisation in Ireland. For this secondary data analysis, a chart review was conducted and adult patient summary files (n = 306) were assessed for measures of appropriateness by a national panel of six AP, including whether each presentation was considered an inappropriate use of ED resources and potentially could be managed by a General Practitioner (GP) within 24–48 h. A subset analysis compared outcomes for patients transported by ambulance with those that were transported to the ED by other means. Results: The AP panellists determined that between 12% to 73% of ED attendances were considered an inappropriate use of ED resources (Inter-rater Agreement 19%, κ = 0.182, p < .001) and that between 12% to 79% of cases were suitable for management by a GP within 24–48 h (Inter-rater Agreement 11%, κ = 0.120, p < .001). Inter-rater agreement was higher for patients transported by ambulance who tended to be older (p < .001), live alone (p ≤ .01), have higher triage scores (p ≤ .01), and be admitted to hospital (p ≤ .01). Conclusions: APs did not reach agreement on what constitutes an ‘inappropriate’ attendance to the ED. The reasons for this are multifactorial but it highlights the complexities in developing alternative care pathways for ED avoidance in the community setting. The potential for development of alternative care pathways in Ireland is significant but requires appropriate supervision and governance to support decision-making for paramedic roles with an expanded scope of practice.
AB - Background: Expansion of paramedic roles in the community could reduce non-urgent emergency department (ED) attendances. In Ireland a knowledge gap exists regarding the development of alternative care pathways that avoid ED conveyance. The aim of this research was to explore inter-rater agreement amongst advanced paramedics (AP) about the ‘appropriateness’ of attendances to the ED in Ireland utilising data from the Better Data, Better Planning (BDBP) Study. Methods: The BDBP study was a multi-centre study investigating factors influencing ED utilisation in Ireland. For this secondary data analysis, a chart review was conducted and adult patient summary files (n = 306) were assessed for measures of appropriateness by a national panel of six AP, including whether each presentation was considered an inappropriate use of ED resources and potentially could be managed by a General Practitioner (GP) within 24–48 h. A subset analysis compared outcomes for patients transported by ambulance with those that were transported to the ED by other means. Results: The AP panellists determined that between 12% to 73% of ED attendances were considered an inappropriate use of ED resources (Inter-rater Agreement 19%, κ = 0.182, p < .001) and that between 12% to 79% of cases were suitable for management by a GP within 24–48 h (Inter-rater Agreement 11%, κ = 0.120, p < .001). Inter-rater agreement was higher for patients transported by ambulance who tended to be older (p < .001), live alone (p ≤ .01), have higher triage scores (p ≤ .01), and be admitted to hospital (p ≤ .01). Conclusions: APs did not reach agreement on what constitutes an ‘inappropriate’ attendance to the ED. The reasons for this are multifactorial but it highlights the complexities in developing alternative care pathways for ED avoidance in the community setting. The potential for development of alternative care pathways in Ireland is significant but requires appropriate supervision and governance to support decision-making for paramedic roles with an expanded scope of practice.
KW - alternative care pathways
KW - emergency department utilisation
KW - paramedic decision-making
UR - https://www.scopus.com/pages/publications/105041497712
U2 - 10.1177/27536386261453935
DO - 10.1177/27536386261453935
M3 - Article
AN - SCOPUS:105041497712
SN - 2753-6386
JO - Paramedicine
JF - Paramedicine
ER -