The Effects of Integrated IT Support on the Prehospital Stroke Process: Results from a Realistic Experiment

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 selfefficacy. 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.

Clinical Reasoning among Registered Nurses in Emergency Medical Services: A Case Study

“…In the initial deductive analysis, the data were sorted to reflect the six phases of an EMS mission specified by Andersson Hagiwara et al (2019): ‘receiving the call’, ‘arriving at the scene’, ‘on scene assessment and treatment’, ‘transport decision and departure’, ‘en route assessment and treatment’ and ‘handover’ (see Table 3). This ordered the data chronologically, which is one way of creating a structure for case study analyses (Yin, 2014).…”

Video support for prehospital stroke consultation: implications for system design and clinical implementation from prehospital simulations

“…The simulations were based on previous research [ 31 ] and were considered realistic, as found from the interviews with all participating clinicians, who expressed that the environment was familiar and the actors captured stroke patients’ symptoms well. We believe that simulation was an effective tool in safely evaluating the potential of video consultation, to attain increased understanding of how the system can be used effectively for stroke assessment, before commencing with clinical implementation.…”

“…To evaluate EMS clinicians’ on-scene patient assessment, we used an instrument for competence assessment by Tavares [ 29 ] and the translated and cultural adapted instrument by Bremer et al [ 30 ]. To this point, there are no clinical studies investigating prehospital patient assessment in this level of detail, hence we provide data collected in a previous study [ 31 ] on prehospital stroke assessment, using the same assessment protocol and type of simulations as we do here. Mann-Whitney U tests were used to determine differences between the historical baseline group and the group participating in the present study.…”

Development of Verified Innovation Process for Healthcare Solutions (VIPHS): A Stepwise Model for Digital Health

“…This test showed that the different systems could communicate with each other effectively without failures. In the last phase, the system was tested in a full-scale realistic operational simulation (roleplay), where an entire ambulance mission from dispatch to handover was simulated [13]. Eleven ambulance teams (22 ambulance clinicians) were recruited to the study.…”

“…Eleven ambulance teams (22 ambulance clinicians) were recruited to the study. The teams were instructed to either start using a computerized decision support system (CDSS), described in [13], or to work as usual. Two representative patient cases with stroke-like symptoms were created.…”