The effect of a Computerised Decision Support System (CDSS) on compliance with the prehospital assessment process: results of an interrupted time-series study.

Magnus Andersson Hagiwara,Björn-Ove Suserud,Maria Henricson,Bengt- Arne Sjöqvist,Boel Andersson-Gäre,Anders Jonsson

doi:10.1186/1472-6947-14-70

Abstract

BackgroundErrors in the decision-making process are probably the main threat to patient safety in the prehospital setting. The reason can be the change of focus in prehospital care from the traditional “scoop and run” practice to a more complex assessment and this new focus imposes real demands on clinical judgment. The use of Clinical Guidelines (CG) is a common strategy for cognitively supporting the prehospital providers. However, there are studies that suggest that the compliance with CG in some cases is low in the prehospital setting. One possible way to increase compliance with guidelines could be to introduce guidelines in a Computerized Decision Support System (CDSS). There is limited evidence relating to the effect of CDSS in a prehospital setting. The present study aimed to evaluate the effect of CDSS on compliance with the basic assessment process described in the prehospital CG and the effect of On Scene Time (OST).MethodsIn this time-series study, data from prehospital medical records were collected on a weekly basis during the study period. Medical records were rated with the guidance of a rating protocol and data on OST were collected. The difference between baseline and the intervention period was assessed by a segmented regression.ResultsIn this study, 371 patients were included. Compliance with the assessment process described in the prehospital CG was stable during the baseline period. Following the introduction of the CDSS, compliance rose significantly. The post-intervention slope was stable. The CDSS had no significant effect on OST.ConclusionsThe use of CDSS in prehospital care has the ability to increase compliance with the assessment process of patients with a medical emergency. This study was unable to demonstrate any effects of OST.

Highlights

Errors in the decision-making process are probably the main threat to patient safety in the prehospital setting
There are studies that suggest that compliance with guidelines in some cases is low in the prehospital setting [10,11,12,13,14]
The result of the present study indicates that the use of the Computerized Decision Support System (CDSS) can increase compliance with the basic assessment process described in the prehospital guidelines

Summary

Introduction

Errors in the decision-making process are probably the main threat to patient safety in the prehospital setting. The use of Clinical Guidelines (CG) is a common strategy for cognitively supporting the prehospital providers. There are studies that suggest that the compliance with CG in some cases is low in the prehospital setting. The present study aimed to evaluate the effect of CDSS on compliance with the basic assessment process described in the prehospital CG and the effect of On Scene Time (OST). Except the unstable settings were the prehospital care is execute, there can be several reasons to poor JDM processes. There are studies that suggest that compliance with guidelines in some cases is low in the prehospital setting [10,11,12,13,14]. The implementation strategies are one possible cause [15], while factors such as guideline visibility, content, design and the level of evidence have been shown in other health-care settings to have an impact on compliance with guidelines [16]

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