Abstract
Background: Emergency health services are under pressure globally. One policy solution has been to develop and employ health professionals, such as nurse practitioners and physician assistants/associates (collectively termed non-medical practitioners) who can undertake some of the work traditionally performed by doctors. The extent of employment, deployment and impact of staffing with a skill-mix that includes such staff is unknown.
Objective(s): The review aimed to map and examine the breadth of existing use of skill-mixed staffing including non-medical practitioners and its outcomes for patients, staff and services.
Design: Scoping review with nested systematic review
Main outcome measures: The extent of adoption of non-medical practitioners in the skill-mix of the emergency department and /urgent treatment centre workforce, factors influencing this, roles and responsibilities held by non-medical practitioners, any outcomes (for patients, staff and health systems) associated with variations in skill-mixed teams where the skill-mix, which includes non-medical practitioners.
Data sources: Medline, EMBASE, CINAHL, PsycInfo, SCOPUS, and Cochrane library were searched from 1st Jan 2010 to 31st October 2022. Google Scholar and OpenGrey were searched to the first 120 unique search results. ‘Cited by‘ options on Scopus and Google Scholar, and reference lists in included articles for the systematic review subset were searched.
Review methods: Double blind abstract and title, followed by full-text screening was undertaken. Included papers were scoped/mapped and a subset included for systematic reviews, further grouped into those explicitly or implicitly examining skill-mix including non-medical practitioners. Data were extracted against templates. Critical appraisal was applied using CASP tools to the systematic review, explicit skill-mix literature.
Results: Internationally, the introduction and adoption of non-medical practitioners in the skill-mix is concentrated in some high-income countries but not universal or standardised, driven by workforce availability. Roles and responsibilities held are varied but not well specified and range in level of independence. Outcomes for patients, staff and health systems associated with variations in skill-mix are reported either neutrally or positively. Where skill-mix (rather than individual roles) is modelled, the addition of NMPs is found to have either neutral or positive impact. The strength of the empirical evidence is in its real-world, research in a variety of settings and populations over time, with few overtly negative empirical data reported. Gaps include being able to analyse by scope of practice or role within the skill-mixed team.
Limitations: A double-blind quality assessment was only carried out on a subset of the literature.
Conclusions: This review contributes evidence about the contribution non-medical practitioners to the skill-mix in emergency departments and urgent treatment centres. It addresses several questions, drawing evidence of a varied employment picture internationally, with equivalent or positive outcomes across organisation, workforce and patient levels.
Future work: Further research is needed, acknowledging variations in scope of practice, and interdependence in the team to assess the contribution of skill-mix, rather than individual groups of staff.
Objective(s): The review aimed to map and examine the breadth of existing use of skill-mixed staffing including non-medical practitioners and its outcomes for patients, staff and services.
Design: Scoping review with nested systematic review
Main outcome measures: The extent of adoption of non-medical practitioners in the skill-mix of the emergency department and /urgent treatment centre workforce, factors influencing this, roles and responsibilities held by non-medical practitioners, any outcomes (for patients, staff and health systems) associated with variations in skill-mixed teams where the skill-mix, which includes non-medical practitioners.
Data sources: Medline, EMBASE, CINAHL, PsycInfo, SCOPUS, and Cochrane library were searched from 1st Jan 2010 to 31st October 2022. Google Scholar and OpenGrey were searched to the first 120 unique search results. ‘Cited by‘ options on Scopus and Google Scholar, and reference lists in included articles for the systematic review subset were searched.
Review methods: Double blind abstract and title, followed by full-text screening was undertaken. Included papers were scoped/mapped and a subset included for systematic reviews, further grouped into those explicitly or implicitly examining skill-mix including non-medical practitioners. Data were extracted against templates. Critical appraisal was applied using CASP tools to the systematic review, explicit skill-mix literature.
Results: Internationally, the introduction and adoption of non-medical practitioners in the skill-mix is concentrated in some high-income countries but not universal or standardised, driven by workforce availability. Roles and responsibilities held are varied but not well specified and range in level of independence. Outcomes for patients, staff and health systems associated with variations in skill-mix are reported either neutrally or positively. Where skill-mix (rather than individual roles) is modelled, the addition of NMPs is found to have either neutral or positive impact. The strength of the empirical evidence is in its real-world, research in a variety of settings and populations over time, with few overtly negative empirical data reported. Gaps include being able to analyse by scope of practice or role within the skill-mixed team.
Limitations: A double-blind quality assessment was only carried out on a subset of the literature.
Conclusions: This review contributes evidence about the contribution non-medical practitioners to the skill-mix in emergency departments and urgent treatment centres. It addresses several questions, drawing evidence of a varied employment picture internationally, with equivalent or positive outcomes across organisation, workforce and patient levels.
Future work: Further research is needed, acknowledging variations in scope of practice, and interdependence in the team to assess the contribution of skill-mix, rather than individual groups of staff.
| Original language | English |
|---|---|
| Place of Publication | Kingston upon Thames, U.K. |
| Publisher | Kingston University |
| Number of pages | 329 |
| DOIs | |
| Publication status | Published - 2025 |