Emergency Advanced Clinical Practitioners: Quality and Acceptability

Abstract

Introduction:
In the United Kingdom, the Advanced Clinical Practitioner in emergency care
has emerged as a newly defined healthcare professional role. Drivers such
as increasing demand on emergency care and reduced supply of clinicians
have contributed to the Royal College of Emergency Medicine developing a
defined Advanced Clinical Practitioner role and curriculum. No primary
research into the impact of the Advanced Clinical Practitioner role currently
exists. Literature and interviews with key stakeholders support clinical quality
and acceptability for other advanced roles. However, these studies have not
considered non-medical professionals autonomously managing
undifferentiated major emergency patient presentations. Such a new role
must compliment the extant multi-disciplinary workforce. Importantly,
stakeholders, including patients, require reassurance that any extended role
provides equal care to the traditional junior doctor model. Patient experience
is a key quality indicator for healthcare provides as such understanding
patient acceptability of this new role is important.

Aims:
To determine if adult major emergency patients receive equal quality of care
from Advanced Clinical Practitioners compared to junior doctors, and to
explore the patient acceptability of the role.

Method:
A mixed method study within two Emergency Departments using a post positivist philosophical paradigm. The study has a positivist epistemology,
weighted towards quantitative data analysis methods, it has also utilised an
interpretivist paradigm, with the use of qualitative data research methods.
Quantitative data from retrospective case note reviews compared the clinical
management of adult major emergency patients by Advanced Clinical
Practitioners to junior doctors, in relation to: patient presentations (sepsis /
fractured neck of femur / paracetamol overdose / Acute Coronary Syndrome
/ Pain); and documentation standards. Patient groups were selected due to
the high presentation frequency, mortality and morbidity risk. Clinical quality
has been defined by nationally validated tools.

The third objectives will use an inductive phenomenological approach with
quantitative and qualitative data collection to determine the level of
acceptability by patients using a questionnaire. Patient acceptability
considers willingness to be seen, level of trust, and acceptability. Current
evidence and national patient survey data themes were utilised to ensure
relevance.

Sensitising interviews with healthcare professionals were used to aid data
analysis for all objectives. University, Trust and Health Research Authority
ethical approval processes have been followed, with methodology, consent,
data collection, and storage processes reviewed to minimise research bias.

Results:
The retrospective case note review had a sample of 635 patients,
representing each group Advanced Clinical Practitioner (n=205), foundation
doctor (n=208) and middle-grade doctors (n=222). The six reviews and their
sub-themes showed the Advanced Clinical Practitioners were no worse than
foundation doctors, middle-grade doctors or the defined delta point in the
study.

The questionnaire from 186 patients showed patients have a high
satisfaction level in relation to: effect of treatment, explanation, examination,
patient involvement, respect, time, and care. With an overall “very satisfied”
satisfaction level. The qualitative data provided support in relation to: care,
professionalism, good advice, politeness, detailed explanation,
communication, adequate time with the clinician, thoroughness,
knowledgeability, good clinical skills including examination and treatment
skills. Although minimal, comments implied confusion over Advanced Clinical
Practitioner identity and negative infrastructural concerns.

Sensitising interviews provided additional scrutiny of the results and further
supported the quality and acceptability of the Advanced Clinical Practitioner
in emergency care.

Conclusion:
The quality of care provided by Advanced Clinical Practitioners to adult major
emergency patients is no worse than that provided by junior doctors, with
several aspects showing a higher level of quality. The study establishes that
patient acceptability exists, with patients having a high regard for the care
received. Major emergency patients are willing to be seen by an Advanced
Clinical Practitioner in emergency care.

Date of Award	22 Jun 2022
Original language	English
Awarding Institution	University of Bath
Supervisor	Andrea Herepath (Supervisor) & Alison Leary (Supervisor)