Productivity in an advanced practitioner-led ambulatory emergency care service

Background: With the development of ambulatory emergency care and same day emergency care, early access to senior decision making by experienced middle-grade doctors or advanced practitioners is key. The COVID–19 pandemic interrupted normal service provision in 2020-present, requiring service development while balancing staffing to provide the safest level of care. Aims: This quality improvement initiative aimed to evaluate advanced practitioners productivity to support ongoing evidence-based workforce planning. Methods: The service development involved an advanced practitioner-led ambulatory emergency care and same-day emergency care service at one hospital in the UK. It followed the plan, do, study, act quality improvement model and collected data from 1 May 2021 to 31 July 2023 Findings: During the first 3 months, the advanced practitioner team had a productivity rate of 0.59 patients per hour compared with 0.69 patients per hour for junior doctors. Over the next 3 months, junior doctor support to ambulatory emergency care and same-day emergency care service was reduced while advanced practitioner-led service provision continued, and advanced practitioner productivity increased to 0.79 patients per hour. Conclusions: Advanced practitioner productivity in the first 3 months ranged from 0.61-0.65 patients per hour, reflecting individual levels of experience, enabling the medical workforce to focus on patients with higher acuity. The service development demonstrated acceptable productivity alongside increasing patient numbers, supporting additional recruitment to the advanced practitioner team.