A pragmatic quasi-experimental multi-site community intervention trial evaluating the impact of Emergency Care Practitioners in different UK health settings on patient pathways (NEECaP Trial)

Mason, Suzanne; O’Keeffe, Colin; Knowles, Emma; Bradburn, Michael; Campbell, Mike; Coleman, Patrick J.; Stride, Chris; O’Hara, Rachel; Rick, Jo

doi:10.1136/emj.2010.103572

Cited by 33 publications

(38 citation statements)

References 14 publications

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“…The methodological quality and fidelity assessment was not completed for studies considered supplemental reports 14 15. Mason et al (2012) assessed the effectiveness of emergency care practitioners across five various healthcare services and, as such, only the data from the ambulance service group (pre-hospital diversion) were extracted for the purposes of this review 19. The characteristics of the included studies are shown in table 1.…”

Section: Resultsmentioning

confidence: 99%

A systematic review examining the impact of redirecting low-acuity patients seeking emergency department care: is the juice worth the squeeze?

et al. 2018

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ObjectivesDiverting patients away from the emergency department (ED) has been proposed as a solution for mitigating overcrowding. This systematic review examined the impact of interventions designed to either bypass the ED or direct patients to other alternative care after ED presentation.MethodsSeven electronic databases and the grey literature were searched. Eligible studies included randomised/controlled trials or cohort studies that assessed the effectiveness of pre-hospital or ED-based diversion interventions. Two reviewers independently screened the studies for relevance, inclusion and risk of bias. Pooled statistics were calculated as relative risks (RR) with 95% confidence intervals (CI) using a random effects model.ResultsFifteen studies were included evaluating pre-hospital (n=11) or ED-based (n=4) diversion interventions. The quality of the studies ranged from moderate to low. Patients deemed suitable for diversion among the pre-hospital studies (n=3) ranged from 19.2% to 90.4% and from 19% to 36% in ED-based studies (n=4). Of the eligible patients, the proportion of patients diverted via ED-based diversion tended to be higher (median 85%; IQR 76–93%) compared with pre-hospital diversion (median 40%; IQR 24–57%). Overall, pre-hospital diversion did not decrease the proportion of patients transferred to the ED compared with standard care (RR 0.92; 95% CI 0.80 to 1.06). There was no significant decrease in subsequent ED utilisation among patients diverted via pre-hospital diversion compared with non-diverted patients (RR 1.09; 95% CI 0.99 to 1.21). Of the three pre-hospital studies completing a cost analysis, none found a significant difference in total healthcare costs between diverted and non-diverted patients.ConclusionThere was no conclusive evidence regarding the impact of diversion strategies on ED utilisation and subsequent healthcare utilisation. The overall quality of the research limited the ability of this review to draw definitive conclusions and more research is required prior to widespread implementation.

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Section: Resultsmentioning

confidence: 99%

A systematic review examining the impact of redirecting low-acuity patients seeking emergency department care: is the juice worth the squeeze?

et al. 2018

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“…181 Where measured, the evidence on patient satisfaction and acceptability of initiatives to manage patients out of hospital and closer to home is positive. The UK studies on paramedic practitioners and ECPs 165,168 found that patient satisfaction was higher in the groups receiving care from the advanced practitioners than those receiving usual care, and other studies of ECPs also found high levels of patient satisfaction 191 and that patients found advice and explanations were clearer. 161,191 A positive effect for carers has also been reported.…”

Section: Effectivenessmentioning

confidence: 98%

“…168 ). There were only two randomised studies 165,181 and one relevant economic evaluation associated with a larger trial of a community falls service.…”

Section: Summary Of Findingsmentioning

confidence: 99%

“…Two studies 160,165 showed that hospital admissions were also reduced in patients managed at home by paramedic practitioners and that patients managed at home had no more subsequent health contacts. 167 Four of the UK studies 154,157,161,168 involved emergency care practitioners (ECPs), a role open to other health-care professionals such as nurses, although in reality dominated by ambulance paramedics, and practised in settings other than ambulance services. The review by Evans et al, 148 which was concerned only with paramedics with extended skills, excluded studies of ECPs.…”

Section: Effectivenessmentioning

confidence: 99%

“…Much of the relevant evidence included in the systematic reviews is derived from the two UK studies comprising a cluster randomised trial of paramedic practitioners 165 and a community intervention trial of ECPs. 168 There is also a single randomised trial of use of computerised clinical decision support (CCDS) software for management of fallers. 181 The rest of the evidence is based in a range of study designs that introduce a number of limitations identified by study authors, including:…”

Section: Qualitymentioning

confidence: 99%

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What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

Turner

Coster

Chambers

et al. 2015

Health Serv Deliv Res

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BackgroundIn 2013 NHS England set out its strategy for the development of an emergency and urgent care system that is more responsive to patients’ needs, improves outcomes and delivers clinically excellent and safe care. Knowledge about the current evidence base on models for provision of safe and effective urgent care, and the gaps in evidence that need to be addressed, can support this process.ObjectiveThe purpose of the evidence synthesis is to assess the nature and quality of the existing evidence base on delivery of emergency and urgent care services and identify gaps that require further primary research or evidence synthesis.Data sourcesMEDLINE, EMBASE, The Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Web of Science.MethodsWe have conducted a rapid, framework-based, evidence synthesis approach. Five separate reviews linked to themes in the NHS England review were conducted. One general and five theme-specific database searches were conducted for the years 1995–2014. Relevant systematic reviews and additional primary research papers were included and narrative assessment of evidence quality was conducted for each review.ResultsThe review was completed in 6 months. In total, 45 systematic reviews and 102 primary research studies have been included across all five reviews. The key findings for each review are as follows: (1) demand – there is little empirical evidence to explain increases in demand for urgent care; (2) telephone triage – overall, these services provide appropriate and safe decision-making with high patient satisfaction, but the required clinical skill mix and effectiveness in a system is unclear; (3) extended paramedic roles have been implemented in various health settings and appear to be successful at reducing the number of transports to hospital, making safe decisions about the need for transport and delivering acceptable, cost-effective care out of hospital; (4) emergency department (ED) – the evidence on co-location of general practitioner services with EDs indicates that there is potential to improve care. The attempt to summarise the evidence about wider ED operations proved to be too complex and further focused reviews are needed; and (5) there is no empirical evidence to support the design and development of urgent care networks.LimitationsAlthough there is a large body of evidence on relevant interventions, much of it is weak, with only very small numbers of randomised controlled trials identified. Evidence is dominated by single-site studies, many of which were uncontrolled.ConclusionsThe evidence gaps of most relevance to the delivery of services are (1) a requirement for more detailed understanding and mapping of the characteristics of demand to inform service planning; (2) assessment of the current state of urgent care network development and evaluation of the effectiveness of different models; and (3) expanding the current evidence base on existing interventions that are viewed as central to delivery of the NHS England plan by assessing the implications of increasing interventions at scale and measuring costs and system impact. It would be prudent to develop a national picture of existing pilot projects or interventions in development to support decisions about research commissioning.FundingThe National Institute for Health Research Health Services and Delivery Research Programme.

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Pitfalls in the Management of Older Patients in the Emergency Department

Sjöstrand

Nickel

2017

Geriatric Emergency Medicine

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A pragmatic quasi-experimental multi-site community intervention trial evaluating the impact of Emergency Care Practitioners in different UK health settings on patient pathways (NEECaP Trial)

Cited by 33 publications

References 14 publications

A systematic review examining the impact of redirecting low-acuity patients seeking emergency department care: is the juice worth the squeeze?

A systematic review examining the impact of redirecting low-acuity patients seeking emergency department care: is the juice worth the squeeze?

What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

Pitfalls in the Management of Older Patients in the Emergency Department

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