Collaborative practices in unscheduled emergency care: role and impact of the emergency care practitioner - qualitative and summative findings

Objective: To identify collaborative instances and hindrances and to produce a model of collaborative practice. Methods: A 12-month (2005-2006) mixed methods clinical case study was carried out in a large UK ambulance trust. Collaboration was measured through direct observational ratings of communication skills, teamwork and leadership with 24 multi-professional emergency care practitioners (ECPs), interviews with 45 ECPs and stakeholders, and an audit of 611 patients Results: Using a generic qualitative approach, observational records and interviews showed that ECPs' numerous links with other professions were influenced by three major themes as follows. (i) The ECP role: for example, ``restricted transport codes'' of communication, focus on reducing admissions, frustrations about patient tasking and conflicting views about leadership and team work. (ii) Education and training: drivers for multi-professional clinically focussed graduate level education, requirements for skill development in minor injury units (MIUs) and general practice, and the need for clinical supervision/mentorship. (iii) Cultural perspectives: a ``crew room'' blue collar view of inter-professional working versus emerging professional white collar views, power and communication conflicts, and a lack of understanding of the ECPs' role. The quantitative findings are reported elsewhere. Conclusions: The final model of collaborative practice suggests that ECPs are having an impact on patient care, but that improvements can be made. We recommend the appointment of ECP clinical leads, degree level clinically focussed multi-professional education, communication skills training, clinical supervision and multi-professional ECP appointments.