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The management of children in unscheduled care services by emergency care practitioners
  1. Colin O'Keefe

Abstract

Background/objectives Emergency 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 ECPs are managing paediatric cases, although there is no evidence for their effective management of this patient group. As part of a multi-centre trial we evaluated ECP effectiveness in the discharge of children following a minor illness or injury care episode.

Methods Three pairs of unscheduled services (urgent care, minor injury unit and out of hours) were included in the trial. Each pair comprised an intervention ECP service and a matched control service employing standard non-ECP providers. All care episodes of patients under the age of 16 were identified from the three pairs of services. The primary outcome was percentage of patients discharged after consultation.

Results Across all services the percentage of patients discharged by ECPs was significantly less than the percentage discharged by standard non-ECP providers (59% vs 66%; X2 = 10.1; df=1; p<0.05). ECPs discharged fewer patients in all three pairs of services and in the Out of Hours (X2=4.1; df=1; p< 0.05) and the Urgent Care Centre (X2=4.7; df=1; p<0.05) pairs the difference in discharge rates was statistically significant.

Implications ECPs do not appear to be as effective as standard health providers in discharging children after care. ECPs may be better targeted at patients groups in which there is better evidence of their effectiveness.

Limitations Findings for these services individually may not be generalisable to other similar service settings. However, nationally, the participating services were not considered atypical in how ECP services had developed. It was not possible to design a randomised study in the context of ECP working because the services were already operational.

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