Advanced Clinical Practitioners in the ED - Trial NCT06355648

Timeline & Enrollment

Primary Outcome

Narrative data,Narrative data

Summary

No patient data is involved in the study. This study is designed to understand better how
 Emergency Care Advanced Clinical Practitioners (EC-ACPs) work in emergency departments (EDs).
 The main research question is:
 
 1) What is the EC-ACP's perception of assimilation into emergency care teams, what tensions
 are created due to the role, and what system adaptations are required to facilitate
 integration?
 
 With secondary aims :
 
 1. What are the common organisational factors that affect the implementation of the EC-ACP
 workforce, and what recommendations can be made to improve Trust-wide implementation?
 
 2. How are EC-ACPs deployed in two contrasting emergency departments, what differences can
 be identified in their Work-As-Done (WAD), and how does this compare to the
 Work-As-Imagined (WAI) of the role?
 
 Participants will all be staff members who work in the hospital. Patient data is not being
 collected or processed. This is a mixed-method study using two approaches to collect data:
 
 1. Observation of the EC-ACPs at work - noting how they interact with colleagues and how
 they are deployed in the ED.
 
 2. Interviews with various staff who work with the EC-ACPs clinically or in various
 managerial or director roles.
 
 Background
 
 In the UK, a health care role has been developed called Advanced Clinical Practitioners
 (ACPs). ACPs work in various clinical settings, but this study focuses on those in Emergency
 Care. While non-medical practitioners have worked in Emergency Departments (EDs) for over 20
 years, the ACP role is relatively new. Most ACPs in ED are from a nursing or paramedical
 background, but they can also be from other allied health professions like physiotherapy.
 After the base qualification, ACPs undertake a three-year masters degree with clinical
 portfolios. Once qualified, the goal is to create clinicians who work alongside doctors,
 seeing, treating, and discharging patients. Unlike previous practitioner roles, EC-ACPs treat
 the whole spectrum of ED patients, from minor injuries and illnesses to the sickest patients
 needing the highest level of care.
 
 These roles were heavily supported by local and political desires to create blended
 workforces to meet increasing patient demands. The problem with implementing ACP roles is
 that initially, little consultation was held with stakeholders in EDs. This has resulted in
 various trade-offs. For example, trainee doctors often feel displaced by trainee ACPs seeking
 to learn the same or similar skills.
 
 Previous research on advanced roles in ED has focused on direct clinical comparisons between
 doctors and practitioners. Researchers have investigated which professional (doctors vs.
 nurse practitioners) triages patients quickest or who is more accurate at interpreting
 X-rays. There are several problems with these approaches. The first is that they can create a
 professional rivalry. The second problem is that these approaches oversimplify what is a more
 complex system of care.

ICD-10 Classifications