Background Emergency Care Practitioners (ECPs) are operational in the UK in a variety of emergency and urgent care settings. However, there is little evidence of the effectiveness of ECPs within these different settings. The aim of this study was to evaluate the impact of ECPs on patient pathways and care in different emergency care settings.
Methods A pragmatic quasi-experimental multi-site community intervention trial comprising five matched pairs of intervention (ECP) and control services (usual care providers): ambulance, care home, minor injury unit, urgent care centre and GP out-of-hours. The main outcome being assessed was patient disposal pathway following the care episode.
Results 5525 patient episodes (n=2363 intervention and n=3162 control) were included in the study. A significantly greater percentage of patients were discharged by ECPs working in mobile settings such as the ambulance service (percentage diff. 36.7%, 95% CI 30.8% to 42.7%) and care home service (36.8%, 26.7% to 46.8%). In static services such as out-of-hours (−17.9%, −30.8% to −42.7%) and urgent care centres (−11.5%, −18.0% to −5.1%), a significantly greater percentage of patients were discharged by usual care providers.
Conclusions ECPs have a differential impact compared with usual care providers dependent on the operational service settings. Maximal impact occurs when they operate in mobile settings when care is taken to the patient. In these settings ECPs have a broader range of skills than the usual care providers (eg, paramedic), and are targeted to specific clinical groups who can benefit from alternative pathways of care (such as older people who have fallen).
Trial Registration No ISRCTN22085282 (Controlled trials.com).
- Emergency care practitioners (ECPs)
- extended roles
- emergency care systems
- admission avoidance
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Funding The study was funded by the United Kingdom National Institute for Health Research (NIHR) programme on Service Delivery and Organisation (SDO). The study funders approved the final protocol and design for the study. However, the views expressed here are those of the authors alone. Funder reference SDO 2005/98.
Competing interests None.
Ethics approval The study received ethical approval through Scottish MREC (06/MRE00/20).
Provenance and peer review Not commissioned; externally peer reviewed.