School of Health and Related Research, University of Sheffield, Sheffield, UK.
Emerg Med J. 2012 Jan;29(1):47-53. doi: 10.1136/emj.2010.103572.
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.
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.
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.
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).
在英国，急救护理人员（ECP）在各种紧急和紧急护理环境中开展工作。然而，在这些不同环境中，ECP 的有效性证据很少。本研究旨在评估 ECP 在不同紧急护理环境中对患者路径和护理的影响。
一项实用的准实验性多站点社区干预试验，包括五个干预（ECP）和对照组（常规护理提供者）配对：救护车、护理院、轻伤单位、紧急护理中心和 GP 非工作时间。评估的主要结果是护理事件后患者的处置路径。
本研究纳入了 5525 例患者（n=2363 例干预组和 n=3162 例对照组）。在移动环境中（如救护车服务）工作的 ECP 中，出院患者的比例显著增加，例如救护车服务（百分比差异 36.7%，95%CI 30.8%至 42.7%）和护理院服务（36.8%，26.7%至 46.8%）。在静态服务中，例如非工作时间（-17.9%，-30.8%至-42.7%）和紧急护理中心（-11.5%，-18.0%至-5.1%），常规护理提供者出院的患者比例显著增加。
与常规护理提供者相比，ECP 在不同的服务环境中具有不同的影响。当他们在移动环境中为患者提供护理时，影响最大。在这些环境中，ECP 比常规护理提供者具有更广泛的技能（例如，护理人员），并且针对可以从替代护理途径中受益的特定临床群体（例如跌倒的老年人）。试验注册号 ISRCTN22085282（controlled-trials.com）。
