Solo emergency care by a physician assistant versus an ambulance nurse: a cross-sectional document study

Abstract

BackgroundThis study compares the assessment, treatment, referral, and follow up contact with the dispatch centre of emergency patients treated by two types of solo emergency care providers in ambulance emergency medical services (EMS) in the Netherlands: the physician assistant (PA), educated in the medical domain, and the ambulance registered nurse (RN), educated in the nursing domain. The hypothesis of this study was that there is no difference in outcome of care between the patients of PAs and RNs.MethodsIn a cross-sectional document study in two EMS regions we included 991 patients, treated by two PAs (n = 493) and 23 RNs (n = 498). The inclusion period was October 2010-December 2012 for region 1 and January 2013-March 2014 for region 2. Emergency care data were drawn from predefined and free text fields in the electronic patient records. Data were analysed using descriptive statistics. We used χ2 and Mann-Whitney U tests to analyse for differences in outcome of care. Statistical significance was assumed at a level of P <0.05.ResultsPatients treated by PAs and RNs were similar with respect to patient characteristics. In general, diagnostic measurements according to the national EMS standard were applied by RNs and by PAs. In line with the medical education, PAs used a medical diagnostic approach (16 %, n = 77) and a systematic physical exam of organ tract systems (31 %, n = 155). PAs and RNs provided similar interventions. Additionally, PAs consulted more often other medical specialists (33 %) than RNs (17 %) (χ2 = 35.5, P <0.0001). PAs referred less patients to the general practitioner or emergency department (50 %) compared to RNs (73 %) (χ2 = 52.9, P <0.0001). Patient follow up contact with the dispatch centre within 72 h after completion of the emergency care on scene showed no variation between PAs (5 %) and RNs (4 %).ConclusionsIn line with their medical education, PAs seemed to operate from a more general medical perspective. They used a medical diagnostic approach, consulted more medical specialists, and referred significantly less patients to other health care professionals compared to RNs. While the patients of the PAs did not contact the dispatch centre more often afterwards.

A retrospective comparison between non-conveyed and conveyed patients in ambulance care

“…Ambulance care in the Netherlands is provided by 25 regional EMSs [ 11 ]. Ambulance care is dispatched through the emergency medical dispatch center, and can be requested via the national emergency number, or by other healthcare professionals (such as the general practitioner or medical specialist).…”

Patient characteristics, triage utilisation, level of care, and outcomes in an unselected adult patient population seen by the emergency medical services: a prospective observational study

“…Another study, which compared EMS nurses and physician assistants (PA) in assessing patients at the scene, reported that PA used a more medical diagnostic approach and assessed more patients to stay at the scene. The PA also consulted more medical specialists in the decision-making process [32]. However, it is not clear which type of additional training that is needed [23].…”

Introducing the physician associate role in Ireland: Evaluation of a hospital based pilot project

“…[24] Increasing clinical activity, such as patient throughput and increased productivity, has been reported as an impact of the PA role. [25,26] Other studies [27][28][29][30] conclude that PAs provide physician-equivalent levels of quality care.…”