Does the use of advanced clinical practitioners as part of the extended surgical team improve efficiency?

Background: The introduction of working time restrictions coupled with a growing, ageing and sicker population has prompted wider reforms for the global workforce. In the UK, this initiated the implementation of extended surgical teams (ESTs) consisting of surgeons and advanced clinical practitioners (ACPs). Aim: This single-centred quantitative retrospective longitudinal study examined the impact of having ACPs as part of the ESTs on quality standards. Method: Secondary data were extracted from patient records for time points before and after the introduction of the EST. A total of 1399 patients were analysed for the outcome variables ‘completion of venous thromboembolism (VTE) risk assessment’ and ‘completion of acute kidney injury (AKI) risk assessment’. Findings: There was a statistically significant reduction in the number of VTE risk assessments completed within 4 hours by doctors when compared with ACPs (OR 0.57; 95% CI 0.35 to 0.95; P=0.03), and AKI risk assessments completed within 4 hours by doctors when compared with ACPs (OR 0.54; 95% CI 0.33 to 0.89; P=0.02). ACPs completed 98% of admission VTE risk assessments compared with 48% of doctors. Conclusions: ACPs completed more VTE and AKI risk assessments and contributed to the national VTE Commissioning for Quality and Innovation goal. Implications for practice: ACPs improve quality standards, patient care and efficiency of pathways. General surgical departments should consider enlisting ACPs as part of the extended surgical team.