An audit of 4679 consecutive emergencies for an emergency care practitioner
Abstract
An audit using a sample of 4679 consecutive emergency patients seen by a single emergency care practitioner working for a statutory ambulance service in England between November 2007 and November 2013. The results show that the most common type of call attended are traumatic injuries followed by medical problems. The data shows that 53% of patients attended were discharged at scene, with another 8.3% referred to specialist pathways and just 29.3% sent to the majors side of the emergency department. Additionally, it is shown that referrals are made appropriately in the vast majority of cases with just 2.4% of attempted referrals being rejected as inappropriate. Whilst further work is needed to quantify how these figures compare to a more traditional paramedic role, it is suggested that the introduction of a few specific skills such as skin glue and the use of antibiotics for chest infections to general paramedic practice could dramatically reduce unnecessary hospital admissions.
Reporting in July 2013, the House of Commons Health Committee (HoCHC) investigated the structure of emergency and urgent care services in England and recognised that ‘in order to enhance the overall system of emergency care…ambulance services should be regarded as a care provider and not a service that simply readies patients for journeys to hospital’ (HoCHC, 2013).
Essentially, this means that rather than simply conveying patients to the local emergency department (ED), paramedics should be looking to either treat in the community or directly refer patients onto specialist pathways. As the committee stated, ‘treating at scene and reducing conveyance rates would contribute to alleviating some of the pressures in emergency departments and offer a better service to patients’ (HoCHC, 2013).
In order to do this it is recommended that there needs to be a workforce of skilled paramedics who can ‘treat more patients at scene, reduce conveyance rates to emergency departments and make difficult judgements about when to bypass the nearest A&E in favour of specialist units’ (HoCHC, 2013). This body of specialist paramedics has in fact been in development for several years, following reports such as Right Skill, Right Time, Right Place published by the NHS Modernisation Agency (NHS MA) in 2004.
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