A community intervention trial to evaluate emergency care practitioners in the management of children

摘要

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.