Productivity of Advanced Clinical Practitioners in Emergency Medicine: A 1-year dual-centre retrospective analysis.

BACKGROUND: The ACP role is relatively new in Emergency Medicine (EM) nationally (RCEM, 2017). This work sought to establish the productivity of EM ACPs within our service, to enable evidence-based workforce planning and national benchmarking of this aspect of the role. METHODOLOGY: Data from 1st January 2018-31st December 2018 was retrospectively collected from two hospitals in the United Kingdom (UK) via electronic patient records. In addition to the number of patients seen by ACPs (attending), the number of patients who were seen by an ACP as a senior review (SR) was collected. The productivity was mapped to ACP experience, with patient acuity and disposal reported. RESULTS: In the study period 239,951 patients were seen in the Emergency Departments (EDs) of the two study hospitals. Overall 20,442 (8.5%) patients received care from an ACP. Mean productivity was 1.03 patients per hour (attending) and 1.53 patients per hour (attending and senior review). DISCUSSION: EM ACPs form part of the RCEM future workforce strategy to overcome some of the contemporary challenges in EM (Hassan, 2018). To our knowledge, this is the first study which has examined and reported the productivity of ACPs in UK EM. CONCLUSION: This paper sets a national benchmark for other EDs by reporting ACP productivity and contributes to the evidence by reporting productivity in other clinician groups. The data presented may be helpful in future national workforce planning for UK EDs.

Radiation exposure during paediatric emergency CT: time we took notice?

INTRODUCTION: Concerns exist about radiation exposure during medical imaging. Comprehensive computerised tomography (CT) dose standards exist for adults, but are incomplete for children. We investigated paediatric CT radiation doses at a NHS Trust in order to define the extent of the risk. METHODS: CT dose indicators (CTDI) were recorded for all scans on paediatric patients from January - December 2011 and benchmarked against American College of Radiologists reference levels (75 mGy for adult head, 25 mGy for adult abdomen, and 20 mGy for paediatric (5-year-old) abdomen). Size-specific dose estimates (SSDE) were calculated based on effective patient diameter as recommended by the American Association of Physicists in Medicine. Student t-test was used to compare CTDI and SSDE values for each anatomical region. RESULTS: Of 53,648 paediatric emergency presentations, CT was requested in 211 (0.39%). One hundred fifty-four patients underwent 169 scans, with the rest being cancelled for clinical improvement or senior overrule. Indication for CT was trauma in 130/154 (90%), of which 55% were after falls, 19% following road traffic collisions, 12% after sporting injury, and 12% after alleged assault. CTDI values were available for 96/169 (57%) scans, with the rest lacking sufficient data. There was no significant difference between CTDI and derived SSDE values. 3% of head scans exceeded the adult head reference level. CONCLUSION: There is wide variation in radiation exposure during paediatric trauma CT, with some scans delivering doses in excess of recommended adult values. There is an urgent need to define standards for radiation dose in paediatric CT for all ages and anatomical regions.