Morton Katherine, Voss Sarah, Adamson Joy, Baxter Helen, Bloor Karen, Brandling Janet, Cowlishaw Sean, Doran Tim, Gibson Andrew, Gutacker Nils, Liu Dan, Purdy Sarah, Roy Paul, Salisbury Christopher, Scantlebury Arabella, Vaittinen Anu, Watson Rose, Benger Jonathan Richard
Faculty of Health and Life Sciences, University of the West of England, Bristol, UK.
Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
BMJ Open. 2018 Oct 3;8(10):e024012. doi: 10.1136/bmjopen-2018-024012.
Pressure continues to grow on emergency departments in the UK and throughout the world, with declining performance and adverse effects on patient outcome, safety and experience. One proposed solution is to locate general practitioners to work in or alongside the emergency department (GPED). Several GPED models have been introduced, however, evidence of effectiveness is weak. This study aims to evaluate the impact of GPED on patient care, the primary care and acute hospital team and the wider urgent care system.
The study will be divided into three work packages (WPs). WP-A; Mapping and Taxonomy: mapping, description and classification of current models of GPED in all emergency departments in England and interviews with key informants to examine the hypotheses that underpin GPED. WP-B; Quantitative Analysis of National Data: measurement of the effectiveness, costs and consequences of the GPED models identified in WP-A, compared with a no-GPED model, using retrospective analysis of Hospital Episode Statistics Data. WP-C; Case Studies: detailed case studies of different GPED models using a mixture of qualitative and quantitative methods including: non-participant observation of clinical care, semistructured interviews with staff, patients and carers; workforce surveys with emergency department staff and analysis of available local routinely collected hospital data. Prospective case study sites will be identified by completing telephone interviews with sites awarded capital funding by the UK government to implement GPED initiatives. The study has a strong patient and public involvement group that has contributed to study design and materials, and which will be closely involved in data interpretation and dissemination.
The study has been approved by the National Health Service East Midlands-Leicester South Research Ethics Committee: 17/EM/0312. The results of the study will be disseminated through peer-reviewed journals, conferences and a planned programme of knowledge mobilisation.
ISRCTN51780222.
英国乃至全球的急诊科面临的压力持续增大,其绩效下降,对患者的治疗效果、安全及就医体验产生了不利影响。一种提议的解决方案是安排全科医生在急诊科工作或与急诊科协同工作(全科医生驻急诊科模式)。目前已引入了多种全科医生驻急诊科模式,然而,其有效性的证据并不充分。本研究旨在评估全科医生驻急诊科模式对患者护理、基层医疗和急症医院团队以及更广泛的紧急护理系统的影响。
本研究将分为三个工作包(WP)。工作包A;映射与分类法:对英格兰所有急诊科当前的全科医生驻急诊科模式进行映射、描述和分类,并与关键信息提供者进行访谈,以检验支撑全科医生驻急诊科模式的假设。工作包B;国家数据的定量分析:使用医院事件统计数据的回顾性分析,将工作包A中确定的全科医生驻急诊科模式的有效性、成本及后果与无全科医生驻急诊科模式进行比较。工作包C;案例研究:采用定性和定量相结合的方法,对不同的全科医生驻急诊科模式进行详细案例研究,包括:对临床护理的非参与性观察、对工作人员、患者及护理人员的半结构化访谈;对急诊科工作人员进行劳动力调查,并分析现有的当地常规收集的医院数据。通过与获得英国政府资本资金以实施全科医生驻急诊科计划的机构进行电话访谈,确定前瞻性案例研究地点。本研究有一个强大的患者和公众参与小组,该小组参与了研究设计和材料准备,并将密切参与数据解读和传播工作。
本研究已获得英国国民健康服务体系东米德兰兹 - 莱斯特南部研究伦理委员会批准:17/EM/0312。研究结果将通过同行评审期刊、会议以及一个计划中的知识传播项目进行传播。
ISRCTN51780222。