Grange Physician Response Unit, Aneurin Bevan Health Board, Newport, UK.
Physician Response Unit, Barts Health NHS Trust, London, UK
Emerg Med J. 2022 Aug;39(8):568-574. doi: 10.1136/emermed-2021-211695. Epub 2021 Sep 30.
Community emergency medicine (CEM) aims to bring highly skilled, expert medical care to the patient outside of the traditional ED setting. Currently, there are several different CEM models in existence within the UK and Ireland which confer multiple benefits including provision of a senior clinical decision-maker early in the patient's journey, frontloading of time-critical interventions, easing pressure on busy EDs and reducing inpatient bed days. This is achieved through increased community-based management supplemented by utilisation of alternative care pathways. This study aimed to undertake a national comparison of CEM services currently in operation.
A data collection tool was distributed to CEM services by the Pre-Hospital trainee Operated Research Network in October 2020 which aimed to establish current practice among services in the UK and Ireland. It focused on six key sections: service aims; staffing and training; job tasking and patient selection; funding and vehicles used; equipment and medication; data collection, governance and research activity.
Seven services responded from across England, Wales and Ireland. Similarities were found with the aims of each service, staffing structures and operational times. There were large differences in equipment carried, categories of patient targeted and with governance and research activity.
While some national variations in services are explained by funding and geographical location, this review process revealed several differences in practice under the umbrella term of CEM. A national definition of CEM and its aim, with guidance on scope of practice and measurable outcomes, should be generated to ensure high standard and cost-effective emergency care is delivered in the community.
社区急诊医学（CEM）旨在将高技能、专家级的医疗护理带给传统急诊环境之外的患者。目前，英国和爱尔兰存在几种不同的 CEM 模式，它们提供了多项益处，包括在患者就诊早期提供高级临床决策者，提前进行时间关键的干预措施，缓解繁忙急诊室的压力并减少住院天数。这是通过增加基于社区的管理并利用替代护理途径来实现的。本研究旨在对目前正在运行的 CEM 服务进行全国性比较。
2020 年 10 月，院前培训生运营研究网络向 CEM 服务机构分发了一份数据收集工具，旨在确定英国和爱尔兰各服务机构的当前实践情况。它主要集中在六个关键部分：服务目标；人员配备和培训；工作任务和患者选择；资金和使用的车辆；设备和药物；数据收集、治理和研究活动。
来自英格兰、威尔士和爱尔兰的 7 个服务机构做出了回应。每个服务机构的目标、人员配备结构和运营时间都存在相似之处。在携带的设备、目标患者类别以及治理和研究活动方面存在很大差异。
尽管服务方面存在一些全国性差异是由资金和地理位置解释的，但此审查过程揭示了在 CEM 这一统称下的实践中存在的几个差异。应该制定 CEM 的国家定义及其目标，包括实践范围和可衡量的结果指南，以确保在社区中提供高标准和具有成本效益的紧急护理。
