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Emergency Care Practitioner In Primary Care
Stuart Miller Emergency Care Practitioner (ECP) South Uttlesford Neighbourhood Group
I am the South Uttlesford Neighbourhood Emergency Care Practitioner
I provide cover for 7 GP practices
An ECP is an extended skills Senior Paramedic with University education in….
Patient Assessment
Acute Medical conditions and Minor Injuries
Chronic Medical Conditions and Health Surveillance
Therapeutic Interventions in Primary Care
To reduce GP hours spent on home visits
To see the patient earlier in the day starting visits by 9.30
Reduce admissions to hospital by putting community services in place the same day
Reducing overnight observation admissions
Dovetailing with services and other proposed service developments
Stuart Miller ECP
Record the number of visits and times of visit
Type of intervention
Length of visit
Onward referrals
Number of patients conveyed to A& E
Clinical appropriateness of the visit
Impact of the visit and outcomes
Stuart Miller ECP
Patient feedback
GP feedback
Indirect impacts of the project
Lessons learned
Stuart Miller ECP
Duty Dr Triages home visits and contacts ECP
ECP visits patient
Clinical discussion with Duty Dr to arrange Px
Safety netting/advice to patient/discharge
If clinically appropriate add patient to acute caseload and follow up through to discharge
Continuity of care and levels of trust have developed between GPs, ECP and patients
Stuart Miller ECP
Patient – 61 yr old male
PC – Chesty Cough – Generalised Coryzal symptoms
HPC – Woke with Sore throat, headache, chest tightness and headache. Felt comparatively well previous day. Non-productive chesty cough.
PHM – Previous ITU admissions with sepsis (UTI and LRTI) Grand mal seizure, Alzheimer’s, Type 2 Diabetes, CKD 4, Encephalitis, Sleep Apnoea on CPAP, CCF, AF, RA, Angina, Essential Hypertension, peri cardiac arrest resulting from apnoeic episode, CABAG triple, ++++
DHx - Polypharmacy – 30 meds on repeat
NKDA
Stuart Miller ECP
Social Hx - Lives with wife, carers QDS, Various
community interventions Cardiac / respiratory specialist nurses.
Non-smoker – Nil Alcohol Examination Looked well, Clubbing, Appeared Anaemic, Well
hydrated. Temp 35.9, O2 sats 95%, Chest expansion and
percussion normal, Lower right basal crackles. BP 110/70, Pulse 66 irregular, Cap refill 1.5 secs CN II-XII NAD, PNS NAD, PERL No GI/GU Symptoms, No dizziness blackouts.
Stuart Miller ECP
Developing LRTI. Discussed case and findings with Duty DR. Agreed to Start Amoxicillin. Due to Hx pt to be closely monitored during treatment. Wife is a very organised and well informed carer. Gave worsening advice (which she didn’t really need). Agreed to revisit next week.
Arrange Bloods
Stuart Miller ECP
21/05/2018 – Symptoms unchanged, no worsening of condition. Full examination repeated, Obs not indicating developing sepsis. Wife states it usually takes at least 2 standard courses of Abx to see benefit.
24/05/2018 – Starting to feel a little better, feels like he is turning a corner, Discussed with Different Duty Dr – Doxycycline started.
Stuart Miller ECP
01/06/2018 – Still has focal chest signs, feels like he has started to deteriorate slightly, 2 days of Doxy left. No sepsis markers. Clarithromycin contraindicated due to drug interactions. Started Co-Amoxiclav.
07/06/2018 – Feeling much better, Right base crackles very feint, 2 days of Co-Amoxiclav left. No further follow ups planned. Safety netting, Discharged.
Stuart Miller ECP
Feedback email form Patients named Dr Hi Stuart, Just wanted to let you know about some feedback I received from the wife of XXXXXX. She was really impressed with your care, both the thoroughness of your assessment, and in particular the care you took in following her husband up during his illness over multiple visits. She said you were a great addition to the team. Best regards, Named GP – John Tasker House
Stuart Miller ECP
ECP’s carrying out 8-10 visits per day Patients are being seen up to 5 hours earlier in
the day, 56% of HV’s completed by midday High patient satisfaction and excellent feedback Reduction in A & E attendance as 25% of patients seen are referred to SPA 12% increase in community referrals keeping
patients at home with the support of community services.
Direct access to community hospital beds / frailty unit
No SUIs, No Complaints, No patient safety issues
Stuart Miller ECP
Stuart has been a Godsend-on a good day for the practice his help is appreciated but on a bad day, (like yesterday) his help is invaluable Dr Mike Tee JTH
Able to take on visits for us each day has meant our day is less pressured and frees up time seeing patients in the surgery, phone calls and other patient related activity. Dr T Robson JTH
Stuart Miller ECP
In addition to the visits we allocate him he is able to follow up these patients in the community thus reducing their likelihood of further attendances both in a GP setting and hospital setting. Dr T Robson JTH.
The service provides much needed support among the growing patient lists and heavy work load as it has ultimately enabled more patients to be seen and cared for. This not only increases patient safety but also satisfaction, and enables those frail or particularly unwell patients to be seen at home where service pressures may have otherwise prevented such a prompt response. Dr L Menozzi Stansted / JTH
Stuart Miller ECP
The quality of clinical assessment is excellent with comprehensive examination and observations, which enables safe decision making when cases are presented back to the relevant GP. Dr L Mennozi Stansted / JTH.
It has been a great service and especially useful for those early-in-the-day visit requests when we are still in surgery. Also to manage workload when there might be lunchtime meetings we need to attend. Dr G Graves JTH.
Stuart Miller ECP
The addition of an Emergency Care Practitioner to our team has transformed daily surgery life. We got to know Stuart well in a short amount of time, and have absolute trust in his clinical judgement. Being able to triage home visits to Stuart has created time during the working day for GPs to focus on other clinical responsibilities. It is hard to imagine how we ever managed without him. T Buglass Practice manager Stansted.
Stuart Miller ECP
“Since Sorting out some water tablets for me you have changed my life”. Patient Eden practice.
“Wonderful service. Very surprised to be seen so early in the day. Thorough assessment. Felt very reassured and well treated”. Patient
Felsted practice
“We really like the ECP visiting. As they start visits earlier in the day the residents feel that they get a bit more time”. Senior Carer. Bings Hall, Felsted
Stuart Miller ECP
Patient Group Directives (PGDs) still in
development Non Medical Prescribing Course starts in April
2019 Clinic sessions within practices for minor illness /
injuries DNACPR documentation Additional patient assessment skills Improved chronic disease management for
housebound patients Improved QOF performance
Stuart Miller ECP
If you would like to discuss the project in more detail please feel free to contact either Liz Adams, Vicky Bryning or myself
Stuart Miller ECP
