Advanced Clinical Practitioners in the ED
Research type
Research Study
Full title
Advanced Clinical Practitioners in the Emergency Department: A mixed-methods study of practice using resilient health care principles.
IRAS ID
337181
Contact name
Andreas Xyrichis
Contact email
Sponsor organisation
Kings College London
Duration of Study in the UK
0 years, 7 months, 1 days
Research summary
In 2006, Trusts developed the Emergency Care Advanced Clinical Practitioner (EC-ACP) role. EC-ACPs are predominantly nurses or paramedics but can be from any allied health profession; they undertake masters-level courses and supervision in practice to enable them to see the complete spectrum of presenting complaints in ED. The EC-ACP role was created to meet higher service demands caused by reduced junior doctors' working hours, medical training changes, increased patient complexity, and higher hospital attendance. There has been extensive support within health policy for advanced practice roles. However, policies focus on the need for a broader workforce performing extended functions but fail to fully address the many systems impacts of advanced practice. Most research on advanced roles in ED has adopted reductionist approaches, comparing nurse practitioners and doctors on individual tasks.
The problem with these methods is that they perpetuate misunderstandings between professional groups, causing tension as differently trained staff are compared on a task-only basis.
Internationally, there is growing interest in using a new approach for researching and understanding complex healthcare systems, called Resilient Healthcare (RHC), which suggests that healthcare work is not simple but complex, adaptive, variable, and unpredictable.
This work is important to understand how EC-ACPs work in practice, how they integrate into teams and what organisational/system barriers exist to their introduction. A central tenant of RHC is comparing how something actually works Work-as-done with how we imagine work to be completed. This has meant that this study has had to be designed as a mixed-methods ethnographic piece of work. Participants for observations will be EC_ACPS, and a mix of ACPs and other team members will be used for interviews. There is no formal funding for the study, and it will be conducted at two Emergency Departments, Nottingham and Bath Hospitals.
REC name
West of Scotland REC 3
REC reference
24/WS/0082
Date of REC Opinion
2 Jul 2024
REC opinion
Unfavourable Opinion