Mason S, Coleman P, O'Keeffe C, Ratcliffe J, Nicholl J
Health Services Research, School of Health and Related Research, University of Sheffield, Sheffield, UK.
Emerg Med J. 2006 Jun;23(6):435-9. doi: 10.1136/emj.2005.027300.
The emergency care practitioner (ECP) is a generic practitioner who combines extended nursing and paramedic skills. The "new" role emerged out of changing workforce initiatives intended to improve staff career opportunities in the National Health Service and ensure that patients' health needs are assessed appropriately.
To describe the development of ECP Schemes in 17 sites, identify criteria contributing to a successful operational framework, analyse routinely collected data and provide a preliminary estimate of costs.
There were three methods used: (a) a quantitative survey, comprising a questionnaire to project leaders in 17 sites, and analysis of data collected routinely; (b) qualitative interpretation based on telephone interviews in six sites; and (c) an economic costing study.
Of 17 sites, 14 (82.5%) responded to the questionnaire. Most ECPs (77.4%) had trained as paramedics. Skills and competencies have been extended through educational programmes, training, and assessment. Routine data indicate that 54% of patient contacts with the ECP service did not require a referral to another health professional or use of emergency transport. In a subset of six sites, factors contributing to a successful operational framework were strategic visions crossing traditional organisational boundaries and appropriately skilled workforce integrating flexibly with existing services. Issues across all schemes were patient safety, appropriate clinical governance, and supervision and workforce issues. On the data available, the mean cost per ECP patient contact is 24.00 pounds sterling, which is less than an ED contact of 55.00 pounds sterling.
Indications are that the ECP schemes are moving forward in line with original objectives and could be having a significant impact on the emergency services workload.
急诊护理从业者（ECP）是一种融合了扩展护理和护理人员技能的全科从业者。这一“新”角色源自不断变化的劳动力计划，旨在改善国民医疗服务体系中员工的职业机会，并确保患者的健康需求得到适当评估。
描述17个地点的ECP计划的发展情况，确定有助于成功运营框架的标准，分析常规收集的数据，并提供成本的初步估计。
使用了三种方法：（a）定量调查，包括向17个地点的项目负责人发放问卷，并分析常规收集的数据；（b）基于对六个地点的电话访谈进行定性解读；（c）经济成本研究。
17个地点中有14个（82.5%）回复了问卷。大多数ECP（77.4%）接受过护理人员培训。技能和能力通过教育计划、培训和评估得到了扩展。常规数据表明，与ECP服务接触的患者中，54%不需要转诊至其他医疗专业人员或使用紧急运输。在六个地点的子集中，促成成功运营框架的因素包括跨越传统组织界限的战略愿景以及技能适当的劳动力与现有服务的灵活整合。所有计划中存在的问题包括患者安全、适当的临床治理以及监督和劳动力问题。根据现有数据，每次ECP患者接触的平均成本为24.00英镑，低于急诊部门接触的55.00英镑。
有迹象表明，ECP计划正在按照原定目标推进，可能会对急诊服务工作量产生重大影响。
