Decision-Support Tool in Prehospital Care: A Systematic Review of Randomized Trials

Abstract

Objective: The objective of this study was to evaluate the effects of the decision support tool (DST) on the assessment of the acutely ill or injured out-of-hospital patient. Methods: This study included systematic reviews of randomized controlled trials (RCT) where the DST was compared to usual care in and out of the hospital setting. The databases scanned include: (1) Cochrane Reviews (up to January 2010); (2) Cochrane Controlled Clinical Trials (1979 to January 2010); (3) Cinahl (1986 to January 2010); and (4) Pubmed/ Medline (1926 to January 2010). In addition, information was gathered from related magazines, prehospital home pages, databases for theses, conferences, grey literature and ongoing trials. Results: Use of the DST in prehospital care may have the possibility to decrease "time to definitive care" and improve diagnostic accuracy among prehospital personnel, but more studies are needed. Conclusions:The amount of data in this review is too small to be able to draw any reliable conclusions about the impact of the use of the DST on prehospital care. The research in this review indicates that there are very few RCTs that evaluate the use of the DST in prehospital care. IntroductionPrehospital patient assessment is different compared to assessments provided in hospitals. Often, the ambulance personnel are sent to medical emergencies with very little background information. The person who initiates the call for help sometimes is not able to describe the situation, and therefore, the ambulance personnel have difficulties preparing themselves for the task. The ambulance personnel's work situation has been described as "extreme". "They have routinely required working in environments of extreme and constant uncertainty." 1 These environmental factors lead to great strain on the prehospital caregiver's ability when assessing patients. In addition, there have been very few randomized controlled trials (RTC) that have evaluated prehospital care. 2 When 14 ambulance nurses in Sweden were asked about factors that influence their decision-making, several factors that were crucial for the decision were elicited. Important factors included: (1) time of day; (2) season and weather; (3) amount of time before other resources could arrive to the scene; (4) if there was threat of security; (5) stress; (6) environment; (7) diagnosis and; (8) type of patient assessed. 3 A qualitative study by Wireklint Sundström described the need of an "open mind" in the performance of prehospital assessments, and noted that prehospital caregivers must put their preconceived ideas aside when they meet and assess patients. 4 As assessments and treatments of patients in prehospital emergency medical care are becoming more advanced and complex, prehospital emergency care is on the eve of a new and emerging role. 5 Many organizations are searching for alternatives to Accident and Emergency (A&E) treatments, 6 but according to a recent systematic review, prehospital personnel's preparedness for this task is poor. 7 Another future task ...

Randomized Controlled Trial of a Prehospital Decision System by Emergency Medical Services to Ensure Optimal Treatment for Older Adults in Sweden

“…In the intervention group, there was an insignificantly (3 minute) longer assignment time for individuals who were sent to a CH than for those sent to the ED. These findings are different from those of earlier studies, which found that using a decision support tool in the prehospital context increased EMS assignment time but in the long run decreased the time until arrival at the final healthcare alternative.…”

“…How to direct older adults is an advanced assessment process, and the system and tool were developed to secure the individual's safety and to guide the ambulance nurses in making correct decisions. There are studies that argue that a decision support tool improves EMS personnel's clinical assessment skills and that a decision support tool is required to help ambulance personnel identify individuals who would benefit from bypassing the ED.…”

Promotion of prehospital emergency care through clinical decision support systems: opportunities and challenges

“…Table 1 shows some studies about the application of decision support systems in prehospital emergency care. 22,[32][33][34][35][36][37][38][39][40][41][42][43][44]…”

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

“…Four features have been identified as important factors for the ability of decision support systems to improve clinical practice; the decision support is computer based, gives support as part of natural workflow, the decision support is delivered at the time and location of the decision making and actionable recommendations are provided [18]. There is limited evidence relating to the effect of CDSS in a prehospital setting [19]. In a recent simulation study of a CDSS effect of compliance to guidelines and CDSS effect of on-scene time (OST), improved guideline compliance was found among the ambulance clinicians who used a CDSS in two simulated patient cases compared with those that used guidelines in the usual paper format, but the group using the CDSS also spend more time on-scene [19].…”

“…There is limited evidence relating to the effect of CDSS in a prehospital setting [19]. In a recent simulation study of a CDSS effect of compliance to guidelines and CDSS effect of on-scene time (OST), improved guideline compliance was found among the ambulance clinicians who used a CDSS in two simulated patient cases compared with those that used guidelines in the usual paper format, but the group using the CDSS also spend more time on-scene [19]. …”