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A community intervention trial to evaluate emergency care practitioners in the management of children
Colin O'Keeffe1, Suzanne Mason, Mike Bradburn
1School of Health and Related Research, University of Sheffield, 30 Regent Street, Sheffield, UK. c.okeeffe@sheffield.ac.uk
Insights
Emergency care practitioners (ECPs) were less effective in discharging children with minor conditions compared to usual care. This suggests ECPs may be better suited for different patient groups or settings.
Area of Science:
- Pediatrics
- Emergency Medicine
- Healthcare Management
Background:
- Unscheduled care settings manage a high volume of pediatric patients with minor conditions.
- The role of emergency care practitioners (ECPs) in pediatric care pathways requires evaluation.
Purpose of the Study:
- To assess the impact of ECPs on the patient care pathway for children with minor conditions in unscheduled care.
- To compare ECPs' effectiveness against usual care providers in pediatric urgent healthcare.
Main Methods:
- A pragmatic, quasi-experimental, multi-site community intervention trial was conducted.
- Data were collected from three pairs of UK-based emergency and urgent care services (MIU, UCC, GP out of hours).
- Paediatric acute episodes (n=415 intervention, n=748 control) presenting with minor conditions were analyzed.
Main Results:
- ECPs discharged significantly fewer children (7.3% difference) than usual care providers.
- This trend was observed across all three service types: out of hours, UCC, and MIU.
- ECPs showed a trend towards increased referrals to hospital and primary care.
Conclusions:
- ECPs demonstrated lower effectiveness in discharging children with urgent healthcare problems compared to usual providers.
- Findings have implications for emergency department workload and pediatric provider resource allocation.
- Targeting ECPs to specific settings and patient groups may enhance their effectiveness.
Objective:
To evaluate the impact of emergency care practitioners (ECPs) on the patient care pathway for children presenting with minor conditions in unscheduled care settings.
Design:
A pragmatic quasi-experimental multi-site community intervention trial comparing ECPs with usual care providers.
Setting:
Three pairs of emergency and urgent care services in the UK: minor injury unit (MIU), urgent care centre (UCC) and general practitioner out of hours.
Patients:
Paediatric acute episodes (n=415 intervention and n=748 control) in participating services presenting with minor conditions.
Main Outcome Measures:
Percentage of patients discharged following care episode and percentage of patients referred to hospital and primary care services. Interventions ECPs operational in emergency and unscheduled care settings.
Results:
ECPs discharged significantly fewer patients than usual care providers (percentage difference 7.3%, 95% CI 13.6% to 0.9%). ECPs discharged fewer patients within all three pairs of services (out of hours percentage difference 6.33%, 95% CI 15.17% to 2.51%; UCC percentage difference 8.73%, 95% CI 19.22% to 1.76%; MIU percentage difference 6.80%, 95% CI 24.36% to 10.75%). ECPs also referred more patients to hospital (percentage difference 4.6%, 95% CI -2.9% to 12.0%) and primary care providers (percentage difference 3.0%, 95% CI 3.7% to 9.7%).
Conclusions:
ECPs are not as effective as usual health providers in discharging children after assessment of urgent healthcare problems. This has implications for the workload of other paediatric providers such as the emergency department. ECPs may be better targeted to settings and patients groups in which there is more evidence of their effectiveness in patient care pathways.
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