Emergency Care Practitioners Research Articles

Can sharing stories change practice? A qualitative study of an interprofessional narrative-based palliative care course

A series of six interprofessional palliative care meetings used narrative, with participants sharing stories from their professional experience in facilitated small groups. The course was attended by doctors, nurses, social workers and emergency care practitioners. The course was evaluated by telephone interview with 19 of the 28 participants. Respondents reported effects including changed behaviours and benefit to patients. The use of narrative, as a starting point for shared learning, discussion and evaluation is unusual. Five months after the end of the course, many participants described changed professional behaviour which they believed led to improved patient outcomes.

Evaluating new roles within emergency care: A literature review

In recent years economic and political drivers have strongly influenced the development and introduction of new roles such as medical substitution roles within emergency care in the National Health Service (NHS) in the United Kingdom (UK). The aims of this literature review were to establish the national and international evidence available which examine the scope of practice of emergency nurse practitioners, emergency care practitioners and extended scope physiotherapists; to establish the national and international evidence which explores patient satisfaction with non-medical roles in emergency care; to establish the national and international evidence which explores the acceptability of emergency nurse practitioner, emergency care practitioner and extended scope physiotherapists services from a healthcare professional perspective. A search of the literature was undertaken using BNI, CINAHL plus, International Bibliography of the Social Sciences, MEDLINE and SPORTDiscus databases combined with searches of the Cochrane library collection, NICE and the grey literature. Critical assessment of the literature is presented. A high level of patient satisfaction was found with all the new roles. Interestingly the scope of practice of Emergency nurse practitioners appears to be most limited in the UK. Five major themes were identified from healthcare professionals' perceptions of these new roles. There is general agreement that non-medical roles help to reduce waiting times in emergency departments, as well as attracting a high level of patient satisfaction, confidence and acceptance of these roles. Several issues were identified which warrant further study; including the current UK evidence surrounding the limited scope of practice of these roles.

Nurse Practitioners in Emergency Care

Nurse Practitioners in Emergency Care

Wound Care and Laceration Repair for Nurse Practitioners in Emergency Care

Advanced Emergency Nursing Journal: October/December 2010 - Volume 32 - Issue 4 - p 373-374 doi: 10.1097/TME.0b013e3181fdbfc4

Wound Care and Laceration Repair for Nurse Practitioners in Emergency Care

This is part one of a 2-part series on wound care and laceration repair for advanced practice nurses. The purpose of this article is to outline the phases and categories of wound healing and to discuss factors that affect wound healing. This article also describes an approach for systematic wound management so as to decrease the risk for infection of nonsurgical wounds. Patient assessment, special circumstances involving underlying structures, and foreign bodies are also discussed herein. Patient preparation, including wound cleansing, irrigation, scrubbing, and debridement are also covered along with anesthetic and analgesic tips and techniques for the advanced practice nurses in emergency care.

Bacterial tonsillitis: prevalence, prediction and treatment by the ECP

Sore throat or tonsillitis is not necessarily considered a life-threatening emergency but such calls are received and attended to by the ambulance service. It is believed that this is because a face-to-face assessment is often required as the symptoms of a high temperature, headache, lethargy, vomiting and a stiff neck are far too similar to those of meningitis. With complex telephone triage now being performed by nurses and emergency care practitioners (ECP) on clinical support desks within most emergency operation centres, it is hoped that this complaint could be narrowed down and a more appropriate ECP response despatched. When presented with tonsillitis in the community, it is difficult for the practitioner to establish whether the infection is of a bacterial or viral origin. Learned behaviour would suggest that white exudates on the tonsils deem a bacterial origin and requires antibiotic treatment, but this can sometimes be a self limiting illness and antibiotic treatment is not indicated and will only assist with resistance. This article looks as the incidence of bacterial tonsillitis, tools to predict bacterial tonsilitis, and the correct antibiotic and length of course once established. It also briefly touches on the Department of Health's current consultation on paramedic prescribing rights and how a delayed prescription treatment plan cannot be achieved working under a patient group directive (PGD) when treating bacterial tonsillitis.

The management of children in unscheduled care services by emergency care practitioners

Background/objectivesEmergency Care Practitioners (ECPs) are an example of a new role in healthcare. ECPs are substituting for standard providers such as doctors in various unscheduled care services. In these services...

Continuing Professional Development: Taking a patient history

Overview The aim of this module is to provide the reader with a detailed insight to taking a patient history, identifying some key issues and outlining the importance of documenting a patient history. Many paramedic and prehospital practitioners will already be documenting a patient history on a regular basis as an aspect of their everyday clinical practice. A patient report form (PRF), or similar documentation will guide the practitioner. Emergency care practitioners (ECPs) or paramedic practitioners (PPs) may also use a medical model to guide their comprehensive patient history, as outlined in this CPD module. However, for most paramedics and other prehospital or urgent care professionals, the practice of taking a comprehensive patient history is perhaps less familiar. This module will provide the reader with a background to the importance of tacking a patient's medical history and also to consider developing and refining these skills. This module will also help to explain any patient history notes that you may have read as part of caring for a patient. This module is aimed largely at adult patients, although specific issues in relation to children are identified where appropriate. Learning Outcomes After completing this module you will be able to: • Demonstrate an understanding of taking and documenting a comprehensive patient history. • Have an understanding of some of the common patient history taking terminology. • Recognize the importance of history taking as a key component in patient assessment. • Begin to develop and apply some patient history taking skills. A note: This history taking outlined in this module is a general approach to taking a patient's history and does not address the specific history taking in relation to an individual illness or disease and therefore is aimed at being generic approach to taking a history from an undifferentiated patient presenting with a health care issue.

ECPs: avoiding emergency department attendance or hospital admission?

The aim of the literature review was to identify and appraise studies that have compared the effectiveness and decision-making of emergency care practitioners with other health professionals. There is no ‘gold standard’ for determining whether the actions of an emergency care practitioner (ECP) results in a patient avoiding attendance at an emergency department (ED) or hospital admission. Consequently, reporting on the cost effectiveness of ECPs is potentially spurious, especially as the cost difference between ED attendance and hospital admission is considerable. Medline and EMBASE databases were searched for publications relevant to the study area. Additional searches were carried out using the online search function offered by the Cochrane Library and the Emergency Medicine Journal. Twenty-nine publications met the inclusion criteria. Nineteen of these papers were considered suitable for background information only. Ten studies were analyzed in further detail and three main themes identified: non-conveyance rates, decision-making and admission avoidance. Studies show that patients assessed by ECPs are less likely to be conveyed to the ED, than when attended by a traditional ambulance response. The Department of Health (DH, 2005) refer to a traditional ambulance service response to a 999 call as sending a double-crewed paramedic ambulance to the patient, provide any necessary life support to stabilize the patient and transport to the ED. The decision-making of ECPs compares favourably with other health professionals when deciding whether a patient can be treated at home, or requires ED attendance or hospital admission. No studies were found that determined whether an ECP is able to accurately decide whether their intervention results in patients avoiding ED attendance or admission. There is a need to evaluate the validity of data collection methods which differentiate between emergency department and admission avoidance as a result of the actions of ECPs.

Portable treatment technologies for urgent care

BackgroundIn recent years UK government policy has increased the provision of urgent care in the community. As part of this initiative the emergency ambulance service is gradually changing from an...

Modular treatment units for prehospital care

In recent years UK government policy has increased the provision of urgent care in the community. As part of this initiative, the ambulance service is gradually changing from an organization designed to convey patients to hospital, to a professional group capable of assessing and delivering appropriate treatment to the patient at scene. This paper explores the technology requirements needed to support new professional roles and draws on examples from ambulance trusts (emergency care practitioners), primary care (out-of-hours general practitioners and minor injuries units) and acute trusts (emergency departments). It describes the iterative process used to develop the design specification for modular treatment units for both vehicle and built environments, using a qualitative exploratory methodological framework. Data were collected with 125 staff and 88 patients over 18 months in five phases using stakeholder workshops (2007 and 2008); portable technology audits; treatment observations in emergency departments and walk-in centres; and design decision groups. The results were thematically coded and triangulated to define the functional design requirements for the modular treatment units. The results are discussed as a technology system for personal kit, assessment packages (and storage for other clinical treatment packages) and a modular clinical workspace.

An interview with Spencer Winch

Having now worked for the Ambulance Service for nearly 10 years, my exposure to wounds would have been as early as my first shift ‘on the road.’ During a busy 12 hour shift, ambulance crews may come into contact with wounds two or three times whether it be an elderly faller, a child fallen off their bicycle, a DIY accident, an assault, a self-harming incident or a bleeding leg ulcer. Until recently, all these wounds would have had a dressing applied, and the patient transported by front-line ambulance to the nearest emergency department (ED) or minor injuries unit (MIU). A large majority of these wounds were very minor and would most likely have required nothing more than a thorough clean, a neurovascular assessment and basic closure with steri-strips, tissue adhesive or suturing. But, there was no personnel within the ambulance service qualified to assess and close these wounds in the pre-hospital environment. This transport to hospital did not benefit the patient, the Ambulance Service or the receiving treatment centre, and so, the emergency care practitioner (ECP) role has evolved and was borne from the recommendations set out in the Department of Health’s (2005) paper Taking Healthcare to the Patient Transforming NHS Ambulance Services. One of the visions was that:

Diagnosing urinary tract infections: an overview

As ambulance services start to develop the role of the emergency care practitioner (ECP), ambulance crews need to understand the types of conditions that can now be referred to and treated by this new group of clinicians. This article sets out to demonstrate how ECPs can assist crews who are concerned that a patient may have a urinary tract infection (UTI), by highlighting the anatomy and physiology of the urinary tract, looking at the common causes of UTIs, showing how a practitioner would formulate a diagnosis and setting out current best treatment options. The article hope to show that by making informed referrals to ECPs the full benefit of the role can be achieved, ensuring best care to the patient who calls upon their skills.

The quality and safety of emergency care practitioner care

An emergency care practitioner (ECP) is a relatively new type of health care provider deployed in different health care settings. Little is known about the safety and quality of care provided by ECPs so as part of a multi-centre workforce evaluation of ECPs, we compared the care provided by ECPs in five “intervention” sites with the care provided by the usual providers (eg …

Emergency care practitioners: shaping a new type of practitioner from existing NHS clinical roles

A key driver in the emergency care practitioner (ECP) initiative was to provide another career pathway for NHS staff to retain a clinical focus. To understand some of the issues facing ECPs, and to stimulate debate around managing new ways of working, we explored the perceived influences of previous background on the integration of ECPs into their new role. As part …

Emergency Care Practitioners: shaping a new type of practitioner from existing NHS clinical roles

Emergency Care Practitioners: shaping a new type of practitioner from existing NHS clinical roles

Is referral to emergency care practitioners by general practitioners in-hours effective?

Objective:To evaluate the cost effectiveness to primary care trusts (PCT) in commissioning general practitioner (GP) referrals in-hours to emergency care practitioners (ECP).Methods:A retrospective case note review for patients referred by...

Wound closure on scene: ethical analysis and reflection

This case study involves the critical analysis and reflection of the ethics involved when an emergency care practitioner closed a 16-year-old patient's self-inflicted wounds at scene, rather than transporting to A&E. The article aims to show the challenges faced by ambulance personnel in the pre-hospital setting when faced with issues surrounding patient autonomy, consent and capacity and how these should be considered on a ‘case by case’ basis.

Spotlight on Research

Cooper and Grant (2009) focus on the changing shape of out-of-hospital urgent care services by examining the international literature to establish which roles have evolved, what the scope of these roles are, and how they contribute to health care provision. The initial literature search returned 268 articles related to new or emerging roles in unscheduled, urgent care. After application of specific inclusion/exclusion criteria, 34 papers were identified as eligible for inclusion within this review. These fell into three categories: aspects of general role development; the emergency care practitioner (ECP) role; and the paramedic practitioner (PP) role. Although these studies were conducted in different contexts and locations, concerns about the expanding scope of practice for paramedics and emergency medical technicians, and the debate as to how best to educate and prepare these practitioners appear to be recurrent themes. Evidence indicates that the two new roles of ECP and PP appear to be linked to high levels of patient satisfaction; a reduction in unnecessary conveyance of patients to emergency departments; and increased utilisation of appropriate referral pathways. However, in all of these studies patient safety issues remain paramount, and the authors recommend that ongoing research and evaluation will be required to fully understand the impact and outcomes of the changes and role developments within out-of-hospital emergency care.

Provision of forensic medical services to police custody suites in England and Wales: Current practice

Introduction Police services within England and Wales are required under the Police and Criminal Evidence Act 1984 to ensure appropriate healthcare to those detained in police custody (forensic medical services). Traditionally doctors have been used by police services to provide an appropriate level of care. Changes within the Act allowed other healthcare professionals (nurses and paramedics and emergency care practitioners) to be included in the provision of such services. The aim of this appears at least in part to have been to reduce the costs of providing such a service. In recent years police services within England and Wales have been outsourced to assorted commercial providers. There are now several different modes of delivery of forensic medical services, which are determined locally by separate police services. Aims This study aimed (a) to determine the different modes of delivery of forensic medical services in England and Wales; (b) to determine the healthcare workload caused by Police and Criminal Evidence Act 1984 Codes of Practice; (c) to determine the relative costs of different service models and (d) to determine availability of such information from the police services. Methods The study was undertaken in two parts – (a) a telephone survey of all police services, and (b) an application to each police service utilising the Freedom of Information Act 2000. Results All police services ( n = 43) in England and Wales were contacted. Of the 41forces that furnished detailed information; 13/41 had a doctor only service; 20/41 had a doctor/nurse service; 6/41 had a doctor/nurse/paramedic service; 1/41 had a doctor/emergency care practitioner service (who may be nurses or paramedic); 1/41 had a doctor/paramedic service. 23/43 services were outsourced to private commercial providers. Mean cost per patient contact (in 17/43 services which supplied data) was GBP 97.25. The cheapest cost per patient contact was the Metropolitan Police Service – a doctor only service (GBP 56.4), the highest Lincolnshire – a doctor only service (GBP 151.1). Mean cost for a doctor only service was GBP 97.1; for a doctor/nurse service – GBP 91.56 and for a doctor/nurse/paramedic service – GBP 115.76. There was no significant difference in costs per patient contact between a doctor only versus mixed HCP delivery of service. Relative costs and 95% confidence intervals expressed as a percentage show that a doctor only model was on average 3.4% lower than a mixed HCP provision, and that a non-outsourced service was on average 9.9% less than an outsourced service. No outsourced service in this study uses a doctor only model. Conclusions The study shows that there was a complete lack of consistency in the recording and availability of information regarding forensic medical services for police services in England and Wales. The information that was obtained suggested that usage of such services varied greatly between police services and that costs of forensic medical services appear to be increased by the use of mixed healthcare professional service delivery and by using external commercial providers.