Quality of solo ambulance care by physician assistants versus ambulance nurses for non-conveyed patients in the Netherlands: An observational study

Lilian Vloet,Thijs Van Zonneveld,Aico Gerritsen,Remco Ebben,Wim Heutz,Daniël Winterink,Sivera Berben

doi:10.12688/f1000research.51745.1

Abstract

Background The aim of this study was to compare the ambulance care process, follow-up care and patient experience between physician assistants and ambulance nurses operating as solo ambulance care providers, for a non-conveyed patient population. Methods An observational design was used. Characteristics of patients and events and the care process were retrieved from the ambulance registration database. Data on follow-up care and patient experience were collected through questionnaires. Results Of the included solo ambulance events, 49/379 (12.9%) were performed by physician assistants, 330/379 (87.1%) were performed by ambulance nurses. For initial complaints and the on-scene diagnoses there were no significant differences between the physician assistants and ambulance nurses. 90/165 (54.5%) of the patients requested follow-up care after being non-conveyed with no significant association between the PA and ambulance nurse group (p=.293). For type of follow-up care, 91.9% of the follow-up emergency care requests in this study came from patients treated by an ambulance nurse. There were no significant differences in patients’ experience for clinician attitude and behavior, treatment, and communication between physician assistants and ambulance nurses, although pain management and explanation about the non-conveyance decision could be improved Conclusions Besides small statistical but not clinically significant differences, this study indicated comparable solo ambulance care provided by a physician assistant or an ambulance nurse concerning the care process, follow-up care and patient experience. Patients treated by physician assistants seek less follow-up emergency care after non-conveyance, compared to ambulance nurses. Overall, patients experienced good attitude and behavior, treatment, and communication of the solo ambulance professional. Future well powered studies to gain insight in effects of PAs in ambulance care are needed, as well as studies in which PAs apply all additional skills they are licensed to.

Highlights

Emergency medical services (EMS) face a challenging environment with an increasing number of ambulance deployments[1,2]
Care process There were more female patients non-conveyed by PAs, compared to ambulance nurses (p=.042) (Table 1)
The average age of the whole group was 43.1 years (SD 24.8) with no differences between the PA and the ambulance nurses’ group (43.2 years vs. 43 years, p=.952). 41.4% of the ambulance was requested between 17.00h-23.00h, there was no difference between PAs and ambulance nurses (p=.233)

Summary

Introduction

Emergency medical services (EMS) face a challenging environment with an increasing number of ambulance deployments[1,2]. Reasons for this increase are a growing population with more complex healthcare problems and comorbidities, repeated requests for ambulance care, and the request of ambulance care for primary care problems[3,4,5,6]. The proportion of non-conveyance is increasing, ambulance care professionals experience the conveyance decision making process as difficult, challenging and often unsupported by guidelines[10,11]. Reviewer Status AWAITING PEER REVIEW Any reports and responses or comments on the article can be found at the end of the article

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