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Open Access Research article

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 Hagiwara12*, Björn-Ove Suserud1, Boel Andersson-Gäre2, Bengt- Arne Sjöqvist3, Maria Henricson2 and Anders Jonsson1

Author Affiliations

1 University of Borås, School of Health Sciences, 501 90 Borås, Sweden

2 School of Health Sciences, Jönköping University, Jönköping 551 11, Sweden

3 Department of Signals and Systems, Chalmers University of Technology, Gothenburg, Sweden

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BMC Medical Informatics and Decision Making 2014, 14:70  doi:10.1186/1472-6947-14-70

Published: 9 August 2014

Abstract

Background

Errors 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).

Methods

In 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.

Results

In 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.

Conclusions

The 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.