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Peer assessment after clinical exposure (PACE): an evaluation of structured peer support for staff in emergency care

28 October 2021
Volume 30 · Issue 19



There is an increasing body of evidence that identifies psychological stressors associated with working in emergency medicine. Peer Assessment After Clinical Exposure (PACE) is a structured programme designed to support staff following traumatic or chronic work-related stressful exposure. The first author of this study created the PACE programme and implemented it in one emergency department (ED).


A service evaluation designed to explore the thoughts and experiences of the staff who accessed the PACE support service.


Participants were selected by a non-probability convenience strategy to represent the ED staff population. The study cohort ranged from junior staff nurse level to emergency consultant. Data were collected using a semi-structured interview and examined by the method of interpretative phenomenological analysis.


This study confirmed the findings of previous research that current pressures within the ED include crowding, time pressure and working within an uncontrollable environment. Eight participants identified an absence of previous emotional support resulting in dissociation and avoidance behaviours following traumatic exposure. Overall, the PACE service was well received by the majority of staff (11/12). There was a positive association with the one-to-one element and the educational component helped to reduce the stigma associated with stress reactions after work-related exposure.


PACE received a positive response from staff. This service presently does not exist elsewhere in the NHS so further research will be needed to evaluate its long-term impact and effectiveness on a wider scale.

It is well recognised that emergency medicine staff are exposed to stressful situations on a daily basis (Burbeck et al, 2002; García-Izquierdo and Ríos-Rísuez, 2012; Kessler et al, 2015; McAleese et al, 2016; Somville et al, 2016). The psychological impact of occupational stressors has been widely acknowledged within other professions such as the fire, police and military services. However, despite being identified as a high-risk occupation, few studies have examined the prevalence and impact of mental health issues among staff in the emergency department (ED) (McAleese et al, 2016; Morrison and Joy, 2016; Glasper, 2020; Ratrout and Hamdan-Mansour, 2020).

The current coronavirus pandemic increases the risk of work-related stress and presents challenges for all NHS workers never experienced before, being described as the ‘perfect storm’ for potential stress-related illness for healthcare staff (Khajuri 2020). A cross-sectional study undertaken in China identified mental health distress among front-line healthcare workers, particularly nurses, and emphasised the need for psychological intervention (Lai et al, 2020).

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