Annie Jenkin

Collaborative practices in unscheduled emergency care: role and impact of the emergency care practitioner—quantitative findings

Objective: To identify collaborative instances and hindrances and to produce a model of collaborative practice. Methods: A 12 month (2005–6) mixed methods clinical case study in a large UK ambulance trust. Collaboration was measured through direct observational ratings of communication skills, teamwork and leadership with 24 multiprofessional emergency care practitioners (ECPs); interviews with 45 ECPs and stakeholders; and an audit of 611 patients. Results: Quantitative observational ratings indicated that the higher the leadership rating the greater the communication ability (p⩽0.001) and teamwork (p⩽0.001), and the higher grade ECPs were rated more highly on their leadership performance. From the patient audit, influences and outputs of collaborative practice are revealed: mean time on scene was 47 mins; 62% were not conveyed; 38% were referred, mainly to accident and emergency; ECPs claimed to make the referral decision in 87% of cases with a successful referral in 96% of cases; and in 66% of cases ECPs claimed that their intervention prevented an acute trust admission. The qualitative interview findings, final collaborative model and recommendations are reported in another paper. Conclusions: The collaborative performance of ECPs varies, but the ECPs’ role does appear to have an impact on collaborative practices and patient care. Final recommendations are reported with the qualitative results elsewhere.

Collaborative practices in unscheduled emergency care: role and impact of the emergency care practitioner—qualitative and summative findings

Objective: To identify collaborative instances and hindrances and to produce a model of collaborative practice. Methods: A 12-month (2005–2006) mixed methods clinical case study was carried out in a large UK ambulance trust. Collaboration was measured through direct observational ratings of communication skills, teamwork and leadership with 24 multi-professional emergency care practitioners (ECPs), interviews with 45 ECPs and stakeholders, and an audit of 611 patients Results: Using a generic qualitative approach, observational records and interviews showed that ECPs’ numerous links with other professions were influenced by three major themes as follows. (i) The ECP role: for example, “restricted transport codes” of communication, focus on reducing admissions, frustrations about patient tasking and conflicting views about leadership and team work. (ii) Education and training: drivers for multi-professional clinically focussed graduate level education, requirements for skill development in minor injury units (MIUs) and general practice, and the need for clinical supervision/mentorship. (iii) Cultural perspectives: a “crew room” blue collar view of inter-professional working versus emerging professional white collar views, power and communication conflicts, and a lack of understanding of the ECPs’ role. The quantitative findings are reported elsewhere. Conclusions: The final model of collaborative practice suggests that ECPs are having an impact on patient care, but that improvements can be made. We recommend the appointment of ECP clinical leads, degree level clinically focussed multi-professional education, communication skills training, clinical supervision and multi-professional ECP appointments.

Emergency care practitioners (ECP): Practice and performance in the UK West country – A case study

In the UK there is a drive to develop referral pathways for a ‘seamless service’ which for ambulance services has led to a series of reports advising on emergency care networks and collaborative practice (DH, 1997, 2000, 2004) aiming for the ‘right response, first time, in time’ (DH, 2005). In addition changes in doctors’ working hours and their out of hours practice have led to the emergence of the emergency care practitioner (ECP) role (JRCALC, 2000). ECPs are defined as an ‘‘advanced practitioner (paramedic or nurse) capable of assessing, treating and discharging/referring patients at the scene’’ (DH, 2005 p. 51). As part of a larger