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

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

Methods: In 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 ?2 and Mann-Whitney U tests to analyse for differences in outcome of care. Statistical significance was assumed at a level of P <0.05.

Results: Patients 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%) (?2=35.5, P<0.0001). PAs referred less patients to the general practitioner or emergency department (50%) compared to RNs (73%) (?2=52.9, P< 0.0001). Patient follow up contact with the dispatch centre within 72 hours after completion of the emergency care on scene showed no variation between PAs (5%) and RNs (4%).

Conclusions: In 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.

1757-7241
1-24
Bloemhoff, Anneke
2c0419c9-5df3-4c33-b915-b412aeec1a24
Schoonhoven, Lisette
46a2705b-c657-409b-b9da-329d5b1b02de
de Kreek, Arjan J.L.
1730325f-b64f-4303-864b-c961a0a63b25
Van Grunsven, Pierre M.
d86f6be8-4138-4ebf-8f8c-05680a6739f8
Laurant, Miranda G.H.
d6b4e83a-0fed-46a4-9738-e11b9150a5e8
Berben, Sivera A.A.
b6255534-a8bb-418b-9961-c320200283cf
Bloemhoff, Anneke
2c0419c9-5df3-4c33-b915-b412aeec1a24
Schoonhoven, Lisette
46a2705b-c657-409b-b9da-329d5b1b02de
de Kreek, Arjan J.L.
1730325f-b64f-4303-864b-c961a0a63b25
Van Grunsven, Pierre M.
d86f6be8-4138-4ebf-8f8c-05680a6739f8
Laurant, Miranda G.H.
d6b4e83a-0fed-46a4-9738-e11b9150a5e8
Berben, Sivera A.A.
b6255534-a8bb-418b-9961-c320200283cf

Bloemhoff, Anneke, Schoonhoven, Lisette, de Kreek, Arjan J.L., Van Grunsven, Pierre M., Laurant, Miranda G.H. and Berben, Sivera A.A. (2016) Solo emergency care by a physician assistant versus an ambulance nurse: a cross-sectional document study. Scandinavian Journal of Trauma Resuscitation and Emergency Medicine, 1-24. (doi:10.1186/s13049-016-0279-3).

Record type: Article

Abstract

Background: This 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.

Methods: In 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 ?2 and Mann-Whitney U tests to analyse for differences in outcome of care. Statistical significance was assumed at a level of P <0.05.

Results: Patients 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%) (?2=35.5, P<0.0001). PAs referred less patients to the general practitioner or emergency department (50%) compared to RNs (73%) (?2=52.9, P< 0.0001). Patient follow up contact with the dispatch centre within 72 hours after completion of the emergency care on scene showed no variation between PAs (5%) and RNs (4%).

Conclusions: In 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.

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Accepted/In Press date: 20 June 2016
e-pub ahead of print date: 29 June 2016
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 397165
URI: http://eprints.soton.ac.uk/id/eprint/397165
ISSN: 1757-7241
PURE UUID: 206c295e-37ac-4915-b763-f1b95aaed3e5
ORCID for Lisette Schoonhoven: ORCID iD orcid.org/0000-0002-7129-3766

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Date deposited: 29 Jun 2016 12:47
Last modified: 17 Dec 2019 01:39

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Contributors

Author: Anneke Bloemhoff
Author: Lisette Schoonhoven ORCID iD
Author: Arjan J.L. de Kreek
Author: Pierre M. Van Grunsven
Author: Miranda G.H. Laurant
Author: Sivera A.A. Berben

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