What are the clinical practice experiences of specialist and advanced paramedics working in emergency department roles? A qualitative study.

Alan Clarke

doi:10.29045/14784726.2019.12.4.3.1

Abstract

Aim:Little is known about paramedics who have left the ambulance service to work in emergency departments (EDs). This study sought to explore the lived experiences of paramedics working in specialist/advanced ED roles, focusing on role transition, influences on effective clinical practice and perceptions of role optimisation. A secondary aim of the study was to make recommendations on the future development of specialist/advanced ED roles for paramedics.Methods:This was a qualitative study utilising descriptive phenomenology to collect and describe the lived experiences of participants via semi-structured interviews. The final sample comprised three emergency care practitioners (ECPs), three student ECPs and two advanced clinical practitioners (ACPs), all Health and Care Professions Council registered paramedics. Interview data were transcribed verbatim and analysed using inductive thematic analysis.Results:Transition to the ED involves significant adjustment to a new clinical environment, responsibilities and decision making.Pre-hospital physical assessment and history taking skills, and experience of autonomous working are pertinent enablers to effective practice within the ED.Difficulties in accessing medication in the ED emerged as a significant barrier to daily practice that could affect the patient experience and influence perceptions of sub-optimal working.Misconceptions by ED staff regarding paramedic competencies could lead to role confusion and make inter-professional working difficult.Opportunities exist for future role expansion into areas such as resus, majors and paediatrics within the ED environment.Conclusions:While role transition to the ED represents a turbulent period for paramedics, elements of pre-hospital paramedic practice transfer directly into ED roles and contribute to effective practice. Participants found that they were accepted and supported to work in the ED setting and spoke positively of future role expansion. A lack of access to medicines presents a significant barrier to current clinical practice and a disparity in practice between paramedics and their nursing counterparts. The change in legislation to allow independent prescribing for advanced paramedics will address some of these issues, but interim improvements are required to extend existing arrangements to paramedics, improving the quality and safety of care they provide and ultimately the patient experience.

Highlights

Since the inception of the paramedic role, the clinical practice of paramedics in the United Kingdom has undergone a paradigm shift as the profession has become integrated into the wider emergency care arena, with the development of specialist and advanced paramedic roles (Gallagher et al, 2016)
While role transition to the emergency departments (EDs) represents a turbulent period for paramedics, elements of pre-hospital paramedic practice transfer directly into ED roles and contribute to effective practice
The change in legislation to allow independent prescribing for advanced paramedics will address some of these issues, but interim improvements are required to extend existing arrangements to paramedics, improving the quality and safety of care they provide and the patient experience

Summary

Introduction

Since the inception of the paramedic role, the clinical practice of paramedics in the United Kingdom has undergone a paradigm shift as the profession has become integrated into the wider emergency care arena, with the development of specialist and advanced paramedic roles (Gallagher et al, 2016). The emergency care practitioner (ECP) and advanced clinical practitioner (ACP) are two examples of roles that can be taken up by paramedics (and other health professions) designed to better manage the complete clinical care of patients presenting to areas such as emergency departments (EDs), minor injury units and out-of-hours services (Health Education England, 2017; Hill, McMeekin, & Price, 2014; Mason, O’Keeffe, Coleman, Edlin, & Nicholl, 2007; Mason et al, 2012; NHS England, 2013). ECPs are proven to be effective at treating and discharging patients without referral to other healthcare professionals in the pre-hospital context, but less effective in this respect when working in out-of-hours or urgent care services (Mason et al, 2012); it is not clear though what influences there are on practice that may contribute to this. Findings from overseas studies and from studies of other UK ED roles, such as the emergency nurse practitioner or advanced nurse practitioner, cannot be generalised to paramedics due to differences in UK service delivery, professional scope of practice and education (Bryson, 2016; Fisher, 2006; Griffin & Melby, 2006; Lloyd-Rees, 2016; Norris & Melby, 2006; Perchie, 2003; Tye & Ross, 2000)

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