Hill Harry, McMeekin Peter, Price Christopher
Institute of Health and Society, University of Newcastle, Newcastle, UK.
Institute for Ageing and Health, Institute of Health and Society, University of Newcastle, Newcastle, UK.
Emerg Med J. 2014 Oct;31(10):853-60. doi: 10.1136/emermed-2013-202660. Epub 2013 Jul 13.
The NHS has seen a great expansion in the number of emergency care practitioners (ECPs) working in prehospital, primary and acute care settings since the role was introduced in 2003. This paper updates and expands on two previous reviews of ECP roles by identifying and discussing all empirical studies to date that examined the impact of ECP services in the NHS.
To summarise the national evidence-based literature on the impact of ECPs on healthcare delivery, effectiveness of practice and related health service resource use.
Searches in MEDLINE, EMBASE and CINAHL databases, and two internet search engines (Google and Google Scholar). Identified publications were screened for relevance and quality before a description and synthesis of their findings. No statistical comparison was undertaken.
Studies from the peer-reviewed literature (n=15) and project reports (n=6) were included. Overall, there was evidence that investment in ECP roles is beneficial for the quality of care reported by patients and cost efficiency savings. There was clear support from staff and patients for ECP services, and a number of studies of high methodological quality described care processes (diagnosis, investigations instigated and treatment initiated) provided by ECPs to be equivalent to or better to that provided by practitioners with traditional roles. Prehospital ECPs provided 'added value' by treating more patients at the scene thereby reducing unnecessary referral to emergency departments. It was often unclear whether the ECP intervention was part of a larger service change and/or new investment.
Successful implementation of the ECP role has been described. Further evaluations should consider whether the beneficial impact of the role transfers equally across all operational settings and patient groups, and is not just a reflection of new investment in clinical services.
自2003年引入急诊护理从业者（ECP）这一角色以来，英国国家医疗服务体系（NHS）中在院前、初级和急性护理环境中工作的急诊护理从业者数量大幅增加。本文通过识别和讨论迄今为止所有检验ECP服务在NHS中影响的实证研究，对之前关于ECP角色的两项综述进行了更新和扩展。
总结关于ECP对医疗服务提供、实践有效性及相关卫生服务资源利用影响的基于全国证据的文献。
检索MEDLINE、EMBASE和CINAHL数据库以及两个互联网搜索引擎（谷歌和谷歌学术）。在对研究结果进行描述和综合之前，对识别出的出版物进行相关性和质量筛选。未进行统计比较。
纳入了同行评审文献中的研究（n = 15）和项目报告（n = 6）。总体而言，有证据表明对ECP角色的投资有利于患者报告的护理质量并节省成本。工作人员和患者对ECP服务给予了明确支持，一些方法学质量高的研究描述了ECP提供的护理过程（诊断、发起的检查和开始的治疗）等同于或优于传统角色从业者提供的护理过程。院前ECP通过在现场治疗更多患者提供了“附加值”，从而减少了不必要的急诊转诊。通常不清楚ECP干预是否是更大规模服务变革和/或新投资的一部分。
已描述了ECP角色的成功实施。进一步的评估应考虑该角色的有益影响是否能在所有运营环境和患者群体中同等体现，而不仅仅是临床服务新投资的反映。
