Abstract
Stroke is a serious condition and the stroke chain of care is a complex. The present study aims to explore the impact of a computerised decision support system (CDSS) for the prehospital stroke process, with focus on work processes and performance. The study used an exploratory approach with a randomised controlled crossover design in a realistic contextualised simulation experiment. The study compared clinical performance among 11 emergency medical services (EMS) teams of 22 EMS clinicians using (1) a computerised decision support system (CDSS) and (2) their usual paper-based process support. Data collection consisted of video recordings, postquestionnaires and post-interviews, and data were analysed using a combination of qualitative and quantitative approaches. In this experiment, using a CDSS improved patient assessment, decision making and compliance to process recommendations. Minimal impact of the CDSS was found on EMS clinicians’ self-efficacy, suggesting that even though the system was found to be cumbersome to use it did not have any negative effects on self-efficacy. Negative effects of the CDSS include increased on-scene time and a cognitive burden of using the system, affecting patient interaction and collaboration with team members. The CDSS’s overall process advantage to the prehospital stroke process is assumed to lead to a prehospital care that is both safer and of higher quality. The key to user acceptance of a system such as this CDSS is the relative advantages of improved documentation process and the resulting patient journal. This could improve the overall prehospital stroke process.
Highlights
Prehospital emergency care refers to the work provided by care personnel to patients with acute health problems outside of the hospital, most often in response to emergency calls and dispatch to patients’ homes, accident scenes or other locations
We present the results of an evaluation of a computerised decision support system (CDSS) prototype for prehospital stroke managements
There was improvement in score of the item “patient assessment” when the team was using the CDSS (t = − 2951, p = 0,014) mean score increasing from 4.09 ± 0.94 to 5.27 ± 0.79
Summary
Prehospital emergency care refers to the work provided by care personnel to patients with acute health problems outside of the hospital, most often in response to emergency calls and dispatch to patients’ homes, accident scenes or other locations. Emergency medical services (EMS) clinicians are key actors in this work. They diagnose and provide care on scene and, if needed, transport patients to a medical facility [1]. Patient outcomes and patient safety is heavily depending on EMS clinicians’ ability to make fast and accurate decisions based on structured assessments. This can be challenging in the prehospital domain due to uncertain or unexpected circumstances, safety issues and access constraints, in combination with different levels in training, practices and skills among prehospital care personnel. One example of a time-critical process is when being dispatched to a patient with stroke symptoms
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