Emergency Advanced Clinical Practitioners: Quality and Acceptability
Research type
Research Study
Full title
Do adult major emergency patients receive equal quality of care by Advanced Clinical Practitioners compared to junior doctors, and what is the patient acceptability of the role; a non-inferiority study.
IRAS ID
230605
Contact name
Sarah Davies
Contact email
Sponsor organisation
Lewisham and Greenwich NHS Trust
Duration of Study in the UK
1 years, 2 months, 0 days
Research summary
Research Question:
Do adult major emergency patients receive equal quality of care by Advanced Clinical Practitioners(ACP’s) compared to junior doctors, and what is the patient acceptability of the role; a non-inferiority study.Background:
ACP’s in emergency care is a new role nationally. Drivers such as increasing demand on emergency care and reduced supply of clinicians (Keogh, 2013; NHS England et al., 2014) have contributed to the Royal College of Emergency Medicine developing a defined ACP role and curriculum (RCEM, 2015). Limited primary research into the impact of the role exists. Literature and interviews with key stakeholders support clinical effectiveness and acceptability for other advanced roles; however these have not considered non-medical clinicians autonomously managing undifferentiated major or resuscitation-area patient presentations.Methodology:
A mixed method approach over a year within two Emergency Departments using institutional theory will address three objectives. The first two use deductive research with a positivism philosophical approach, applying quantitative methods of retrospective case note reviews to compare the clinical management of adult major emergency patients by ACPs and junior doctors in relation to: patient presentations (sepsis/ fractured neck-of-femur/ paracetamol-overdose/ Acute-Coronary-Syndrome/ Pain); and documentation standards. Quality will be defined by nationally validated standards. Focused sensitizing one-to-one interviews will be conducted to provide further analysis.The third objective utilises inductive phenomenology with a questionnaire to determine patient acceptability. Acceptability will consider willingness to be seen, trust, and satisfaction. To ensure a validated tool, existing data and existing validated tools will be explored.
Local and national ethics approval will be gained and stringent methodology applied to minimise research bias.
Relevance to Practice:
It is anticipated findings will ascertain whether the ACP role provides comparable quality of care to undifferentiated major emergency patients. Further understanding of patient acceptability of the role is expected. Outcomes are directly transferable nationally.REC name
London - Dulwich Research Ethics Committee
REC reference
17/LO/1698
Date of REC Opinion
6 Nov 2017
REC opinion
Further Information Favourable Opinion