Is there a role for an advanced practitioner in UK military prehospital care?

2021 ◽  
pp. e001781
Author(s):  
Elizabeth Paxman ◽  
D Lamb ◽  
S Findlay
Keyword(s):  
Patient Care ◽  
Clinical Experience ◽  
Emergency Care ◽  
Healthcare Professionals ◽  
Care Pathway ◽  
Prehospital Care ◽  
Advanced Practice ◽  
Advanced Practitioner ◽  
The Military

Recruitment and retention of doctors have been highlighted as some of the leading causes of the current perceived crisis within civilian emergency care. Indeed, the NHS recognises the contribution made by other healthcare professionals by supporting accreditation in advanced practice to mitigate the risks associated with these capability gaps. Consequently, roles such as the advanced clinical practitioner are now well established. Previous research and clinical experience in the civilian sector suggest that the advanced practitioner (AP) role could be used within Defence. Operationally, the role could be advantageous for the Defence Medical Services in the delivery of deployed healthcare. However, there is no available research that defines the role of UK military APs and, more specifically, their potential to support deployed prehospital care. Further work is required to determine how an AP might be effectively used within the military prehospital patient care pathway.

Military Prehospital Emergency Care: defining and professionalising the levels of care provided along the Operational Patient Care Pathway

2018 ◽  
Vol 165 (3) ◽  
pp. 188-192 ◽  
Author(s):  
Danny Sharpe ◽  
J McKinlay ◽  
S Jefferys ◽  
C Wright
Keyword(s):  
Patient Care ◽  
Emergency Care ◽  
Care Pathway ◽  
Prehospital Care ◽  
The Body ◽  
Prehospital Emergency Care ◽  
Levels Of Care ◽  
Prehospital Emergency ◽  
The Right ◽  
Care Support

The Defence Medical Services aims to provide gold standard care to ill and injured personnel in the deployed environment and its prehospital emergency care (PHEC) systems have been proven to save lives. The authors have set out to demonstrate, using existing literature, consensus and doctrine that the NHS Skills for Health framework can be reflected in military prehospital care and provides an existing model for defining the levels of care our providers can offer. In addition, we have demonstrated how these levels of care support the Operational Patient Care Pathway and add to the body of evidence for the use of specialist PHEC teams to allow the right patient to be transported on the right platform, with the right medical team, to the right place. These formalised levels allow military planners to consider the scope of practice, amount of training and appropriate equipment required to support deployed operations.

scholarly journals Using and implementing care bundles for patients with acute admission for COPD: qualitative study of healthcare professionals’ experience in four hospitals in England

2020 ◽  
Vol 7 (1) ◽  
pp. e000515
Author(s):  
Ali Shaw ◽  
Katherine Morton ◽  
Anna King ◽  
Melanie Chalder ◽  
James Calvert ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Patient Care ◽  
Financial Incentives ◽  
Healthcare Professionals ◽  
Care Delivery ◽  
Care Pathway ◽  
Chronic Obstructive ◽  
Process Of Care ◽  
Care Bundles ◽  
The Impact

BackgroundCare bundles are sets of evidence-based interventions to improve quality of hospital care at admission and discharge. Within a wider multi-method evaluation of care bundles for adults with an emergency admission for acute exacerbations of chronic obstructive pulmonary disease, a qualitative study was conducted. The aim was to evaluate how bundles were used, and healthcare professionals’ experiences of the impact of bundles on the process of care delivery.MethodsWithin the wider evaluation, four acute hospitals that were using COPD care bundles were purposefully sampled for geographical variation. Qualitative data were gathered through non-participant observation of patient care and interviews with healthcare professionals, patients and carers. This paper reports a thematic analysis of data from observation and interviews with professionals.ResultsHealthcare professionals generally experienced care bundles as positive for standardising working practices and patient care, valuing how bundles could support a clear care pathway for patients, enable transitions between settings and identify postdischarge support required by patients. Successful use of bundles was perceived as more likely with the presence of either (or both) a clinical champion for bundles and system-based initiatives such as financial incentives, within a local culture of quality improvement. Challenges in accurately diagnosing COPD hampered bundle use, including delivery of bundles to those subsequently considered ineligible, or missed opportunities to deliver admission bundles to those with COPD.ConclusionCare bundles shape admission and discharge care processes for patients with COPD, from the perspective of staff involved in their delivery. However, different organisational, staff and clinical factors aid or hinder bundle use in an acute hospital context, suggesting potentially resolvable reasons for variable implementation of bundles. Finally, bundles may enhance staff experience of care delivery, even if the impact on patient outcomes remains uncertain.

scholarly journals Why Paramedics Require “Theories-of-Practice”

2015 ◽  
Vol 6 (2) ◽  
Author(s):  
Anthony Campeau
Keyword(s):  
Patient Care ◽  
Health Care Professionals ◽  
Research Training ◽  
Prehospital Care ◽  
Self Awareness ◽  
Specific Patient ◽  
Theories Of Practice ◽  
Develop Theory ◽  
Almost All

This article discusses the role of Theories-of-Practice for health care professionals and specifically focuses on the need for such theories in the paramedic profession. Key benefits to the development of paramedic theory include occupational differentiation and self-awareness, and identification of appropriate research topics. Almost all paramedic research, training and practice are focused on specific patient care assessments and interventions. A quick perusal of any Emergency Medical Service or prehospital care journal will reveal an impressive list of research articles that are focused on demonstrating the value (or absence thereof) of patient care procedures. This is important work, and indeed such research is required in order to appropriately define the medical aspects of paramedics’ scopes-of-practice. However, there is an equally important need to research and develop theory about the whole practice of paramedicine as a profession. This perspective is different from narrowly focusing on discrete, technical patient care interventions, because it seeks to define the occupation more comprehensively, inclusive of all types of professional knowledge. When considering professional matters such as these, one cannot avoid comparisons to other professions and the interest in such theories among other health professions has been variable.

Prospective cohort survey of patient satisfaction with on-treatment review by advanced practice urology radiographer

2008 ◽  
Vol 7 (4) ◽  
pp. 205-212 ◽  
Author(s):  
Jo Treeby
Keyword(s):  
Patient Satisfaction ◽  
Patient Care ◽  
Advanced Practice ◽  
Site Specific ◽  
Treatment Review ◽  
Advanced Practitioner ◽  
Trained Individual ◽  
Negative Effect ◽  
Enhance Patient Care ◽  
A Site

ABSTRACTRadiographers are undertaking roles that are a development and extension of what has traditionally been seen as their remit. As with any development, it is important that such changes in practise have a positive rather than negative effect on patient care and patient experience. This article examines patient perception and level of patient satisfaction of an ‘on-treatment review’ conducted by a site-specific advanced practitioner radiographer instead of an oncology doctor. Overall, the results were positive suggesting that such reviews, when conducted by an appropriately trained individual, can enhance patient care and provide a satisfactory level of support during treatment.

Role of advanced practice providers (APP) in meeting rising demands on oncology practices.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18372-e18372
Author(s):  
Bela Bapat ◽  
Yolaine Smith ◽  
Andrew Klink ◽  
Chadi Nabhan ◽  
Bruce A. Feinberg
Keyword(s):  
Patient Care ◽  
Nurse Practitioners ◽  
Physician Assistants ◽  
Patient Treatment ◽  
Advanced Practice ◽  
Physician Burnout ◽  
Community Oncology ◽  
Practice Efficiency ◽  
Physician Availability

e18372 Background: The role of advanced practice providers (APPs), nurse practitioners (NPs) and physician assistants (PAs), is expanding in oncology for myriad reasons including improving access to care by closing the gap between demand for services and physician availability. This is especially true in oncology, where the shortage of oncologists and increasingly cited physician burnout is creating challenges for many practices and communities. Methods: We surveyed US physicians to understand their practices’ use of APPs, their role in patient treatment and support as well as their impact on practice workflow. Data were collected using web-based instrument between Sep 2018 and Nov 2018. Responses have been summarized using descriptive statistics. Results: Among 163 oncologists and hematologists surveyed, 74.2% (n = 121) employed NPs, 39.9% (n = 65) employed PAs, and 19.0% (n = 31) did not employ any APPs in their practice. Amongst practices that employed ≥1 APP (n = 132; 81.0%), over 40% of physicians reported a 1:3 APP: physician ratio. Most (62.1%) physicians stated that APPs only evaluated and saw returning patients, whereas 35.6% physicians used APPs to evaluate and see both new and return patients. More than 60% of physicians stated that APPs enhanced their practice efficiency, enabled physicians to focus more on complex patient cases, and made their workload manageable. By employing APPs, 52.3% of physicians were able to increase their patient caseload. The majority (57.6%) of physicians reported that they would employ more APPs in the next 3 years if resources were available, and 41.7% of physicians reported that APPs would likely take on additional responsibility in the next 3 years. Conclusions: Most community oncology practices in the US are employing APPs and are finding significant value in the APP roles by delegating various aspects of patient care to them. Most community practices are considering increasing the number of employed APPs and to expand the breadth of their responsibility. Integrating APPs into oncology practices is likely to have a larger impact on quality of patient care and potential mitigation of physician burnout.

Systematic approach to delivering prolonged field care in a prehospital care environment

2020 ◽  
pp. jramc-2019-001224 ◽  
Author(s):  
Michael Smith ◽  
K Johnston ◽  
R Withnall
Keyword(s):  
Patient Care ◽  
Hospital Care ◽  
Care Pathway ◽  
Prehospital Care ◽  
Care Process ◽  
Patient Specific ◽  
Prototype Model ◽  
Clinical Guidance ◽  
Resource Limited ◽  
Patient Morbidity

BackgroundThis article describes a novel patient care algorithm which provides a Role 1 (R1) medic with a structured approach to delivering prolonged field care (PFC) in a resource-limited environment. PFC is a vital component of the operational patient care pathway providing the continuum of care from completion of a primary survey to the delivery to hospital care. Future operational environments are likely to have more fragile or extended lines of communication, potentially delaying evacuation to hospital care. This delay may lead to increases in patient morbidity and mortality. Effective PFC offers an opportunity to improve patient outcomes and help mitigate against this risk.MethodsAn initial prototype model of a PFC care process was developed using existing hospital-based guidance. A series of medical and trauma vignettes and best available evidence were used to refine the algorithm.ResultsThe algorithm has been designed be used in conjunction with patient specific clinical guidance making the approach generalisable for all patient groups. For UK military, clinical guidance is provided by clinical guidelines for operations. The algorithm can be downloaded into a convenient format to be used on mobile devices or printed as an aide memoire.

scholarly journals The Role of Emergency Care in Patients with Advanced Dementia

2017 ◽  
Vol 12 (1) ◽  
Author(s):  
Kieran Lewis Quinn
Keyword(s):  
Palliative Care ◽  
Emergency Care ◽  
Care Pathway ◽  
Advanced Dementia ◽  
Emergency Physicians ◽  
Comfort Zone ◽  
The Moment ◽  
Trajectory Of Care ◽  
Physician Workload

The prevalence of advanced dementia (AD) is expected to increase dramatically over the next few decades.  Patients with AD suffer from recurrent episodic illnesses that frequently result in transfers to acute care hospitals.  The default pathway followed by the emergency physicians, internists and intensivists who see those patients there is prioritize disease-directed therapies over attention to the larger picture of advanced dementia.  While this strategy is desired by many families, some families prefer a different approach.  This essay examines the reason why this phenomenon occurs and offers suggestions for improvement.  Gaps in information and physician workload are important factors, but we argue that until physicians who see patients in emergency departments learn to pause first and ask “Why are we doing this?" they will revert to their comfort zone of ordering tests and therapies that may be unwanted.  A separate emergency palliative care pathway may be one solution.  Shifting the focus back to the larger picture of AD and away from the physiologic disturbance of the moment may alter the trajectory of care in ways that truly respect the wishes of some patients and their families.

scholarly journals Affordable Care Act: A review and discussion of its impact on healthcare today, and a primer for pharmacists

2013 ◽  
Vol 4 (1) ◽  
Author(s):  
Leo Lai Ho Lui ◽  
Albert Wertheimer
Keyword(s):  
United States ◽  
Patient Care ◽  
Affordable Care Act ◽  
Healthcare Costs ◽  
Healthcare Professionals ◽  
The United States ◽  
Patient Protection ◽  
The Future ◽  
The Impact

In the midst of countless healthcare debates, the Patient Protection and Affordable Care Act is written into legislation as a possible solution to the United States's rising healthcare costs. Individualized into nine titles, the act sought to provide additional coverage to millions of Americans while cutting down healthcare costs through numerous provisions effective into 2020. While the act has been challenged publicly and privately by the states, many healthcare professionals today, let alone the average American, are unaware and uneducated of what comprises the act, as well as the impact in which it has on the future of healthcare in the United States. With an increasing role of patient care placed upon pharmacists today, an understanding of the PPACA allows us to provide extensive answers to questions in which our patients may have.   Type: Student Project

scholarly journals The role of the emergency medical dispatch centre (EMDC) and prehospital emergency care safety: results from an incident report (IR) system

CJEM ◽  
2015 ◽  
Vol 17 (4) ◽  
pp. 411-419 ◽  
Author(s):  
Alberto Mortaro ◽  
Diana Pascu ◽  
Tamara Zerman ◽  
Enrico Vallaperta ◽  
Alberto Schönsberg ◽  
...  
Keyword(s):  
Emergency Care ◽  
Prehospital Care ◽  
Prehospital Setting ◽  
Prehospital Emergency Care ◽  
Incident Report ◽  
Emergency Medical Dispatch ◽  
Emergency Medical ◽  
Dispatch Centre ◽  
Prehospital Emergency

AbstractIntroductionThe role of the emergency medical dispatch centre (EMDC) is essential to ensure coordinated and safe prehospital care. The aim of this study was to implement an incident report (IR) system in prehospital emergency care management with a view to detecting errors occurring in this setting and guiding the implementation of safety improvement initiatives.MethodsAn ad hoc IR form for the prehospital setting was developed and implemented within the EMDC of Verona. The form included six phases (from the emergency call to hospital admission) with the relevant list of potential error modes (30 items). This descriptive observational study considered the results from 268 consecutive days between February and November 2010.ResultsDuring the study period, 161 error modes were detected. The majority of these errors occurred in the resource allocation and timing phase (34.2%) and in the dispatch phase (31.0%). Most of the errors were due to human factors (77.6%), and almost half of them were classified as either moderate (27.9%) or severe (19.9%). These results guided the implementation of specific corrective actions, such as the adoption of a more efficient Medical Priority Dispatch System and the development of educational initiatives targeted at both EMDC staff and the population.ConclusionsDespite the intrinsic limits of IR methodology, results suggest how the implementation of an IR system dedicated to the emergency prehospital setting can act as a major driver for the development of a “learning organization” and improve both efficacy and safety of first aid care.

Prioritizing pharmacogenomics implementation initiates – survey of healthcare professionals

2021 ◽  
Author(s):  
Teresa T Ho ◽  
Maja Gift ◽  
Earnest Alexander
Keyword(s):  
Clinical Practice ◽  
Patient Care ◽  
General Hospital ◽  
Healthcare Professionals ◽  
South Florida ◽  
Advanced Practice ◽  
The Past ◽  
The University

Aim: Characterize current perceptions, practices, preferences and barriers to integrating pharmacogenomics into patient care at an institution with an established pharmacogenomics clinic. Materials & methods: A 16-item anonymous survey was sent to healthcare professionals practicing at Tampa General Hospital and the University of South Florida Health. Results: Survey participants consisted of nine advanced practice providers, 41 pharmacists and 64 physicians. Majority of survey participants did not feel confident in their ability to interpret and apply pharmacogenomic results. In the past 12 months, 27% of physicians reported ordering a pharmacogenomic test. The greatest reported barrier to integrating pharmacogenomics was the absence of established guidelines or protocols. Conclusion: Most clinicians believed pharmacogenomics would be useful in their clinical practice but do not feel prepared to interpret pharmacogenomic results.

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