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

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.