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Quality and safety of care provided by emergency care practitioners
  1. Rachel O'Hara1,
  2. Colin O'Keeffe2,
  3. Suzanne Mason2,
  4. Joanne E Coster2,
  5. Allen Hutchinson1
  1. 1Section of Public Health, ScHARR, University of Sheffield, Sheffield, UK
  2. 2Section of Health Services Research, ScHARR, University of Sheffield, Sheffield, UK
  1. Correspondence to Dr Rachel O'Hara, Section of Public Health, ScHARR, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK; r.ohara{at}


Background The emergency care practitioner (ECP) role in the UK health service involves paramedic and nurse practitioners with advanced training to assess and treat minor illness and injury. Available evidence suggests that the introduction of this role has been advantageous in terms of managing an increased demand for emergency care, but there is little evidence regarding the quality and safety implications of ECP schemes.

Objectives The objectives were to compare the quality and safety of care provided by ECPs with non-ECP (eg, paramedic, nurse practitioner) care across three different types of emergency care settings: static services (emergency department, walk-in-centre, minor injury unit); ambulance/care home services (mobile); primary care out of hours services.

Methods A retrospective patient case note review was conducted to compare the quality and safety of care provided by ECPs and non-ECPs across matched sites in three types of emergency care settings. Retrospective assessment of care provided was conducted by experienced clinicians. The study was part of a larger trial evaluating ECP schemes (

Results Care provided by ECPs was rated significantly higher than that of non-ECPs across some aspects of care. The differences detected, although statistically significant, are small and may not reflect clinical significance. On other aspects of care, ECPs were rated as equal to their non-ECP counterparts.

Conclusions As a minimum, care provided should meet the standards of existing service models and the findings from the study suggest that this is true of ECPs regardless of the service they are operational in.

  • Emergency care practitioners (ECPs)
  • safety
  • quality
  • emergency ambulance systems
  • effectiveness
  • emergency care systems
  • major incidents
  • clinical care
  • management
  • quality assurance
  • prehospital care
  • advanced practitioner

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  • Funding NETSCC, SDO Alpha House Enterprise Road University of Southampton Science Park Southampton SO16 7NS. The study was funded by the UK National Institute for Health Research (NIHR) program on Service Delivery and Organisation (SDO). However, the views expressed are those of the authors alone.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Scottish Multi-centre Research Ethics Committee (06/MRE00/20).

  • Provenance and peer review Not commissioned; externally peer reviewed.