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Implementation and use of computerised clinical decision support (CCDS) in emergency pre-hospital care: a qualitative study of paramedic views and experience using Strong Structuration Theory

Alison Porter Orcid Logo, Jeremy Dale, Theresa Foster, Pip Logan, Bridget Wells, Helen Snooks Orcid Logo

Implementation Science, Volume: 13, Issue: 1

Swansea University Authors: Alison Porter Orcid Logo, Bridget Wells, Helen Snooks Orcid Logo

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Abstract

BackgroundComputerised clinical decision support (CCDS) has been shown to improve processes of care in some healthcare settings, but there is little evidence related to its use or effects in pre-hospital emergency care. CCDS in this setting aligns with policies to increase IT use in ambulance care,...

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Published in: Implementation Science
ISSN: 1748-5908
Published: Springer Science and Business Media LLC 2018
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CCDS in this setting aligns with policies to increase IT use in ambulance care, enhance paramedic decision-making skills, reduce avoidable emergency department attendances and improve quality of care and patient experience. This qualitative study was conducted alongside a cluster randomised trial in two ambulance services of the costs and effects of web-based CCDS system designed to support paramedic decision-making in the care of older people following a fall. Paramedics were trained to enter observations and history for relevant patients on a tablet, and the CCDS then generated a recommended course of action which could be logged. Our aim was to describe paramedics&#x2019; experience of the CCDS intervention and to identify factors affecting its implementation and use.MethodsWe invited all paramedics who had been randomly allocated to the intervention arm of the trial to participate in interviews or focus groups. The study was underpinned by Strong Structuration Theory, a theoretical model for studying innovation based on the relationship between what people do and their context. We used the Framework approach to data analysis.ResultsTwenty out of 22 paramedics agreed to participate. We developed a model of paramedic experience of CCDS with three domains: context, adoption and use, and outcomes. Aspects of context which had an impact included organisational culture and perceived support for non-conveyance decisions. Experience of adoption and use of the CCDS varied between individual paramedics, with some using it with all eligible patients, some only with patients they thought were &#x2018;suitable&#x2019; and some never using it. A range of outcomes were reported, some of which were different from the intended role of the technology in decision support.ConclusionImplementation of new technology such as CCDS is not a one-off event, but an ongoing process, which requires support at the organisational level to be effective.Trial registrationISRCTN Registry 10538608. Registered 1 May 2007. 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spelling 2022-11-11T15:10:07.4317490 v2 40947 2018-07-06 Implementation and use of computerised clinical decision support (CCDS) in emergency pre-hospital care: a qualitative study of paramedic views and experience using Strong Structuration Theory fcc861ec479a79f7fb9befb13192238b 0000-0002-3408-7007 Alison Porter Alison Porter true false c7b87b8f9a9c4785e14ec3d506c5f185 Bridget Wells Bridget Wells true false ab23c5e0111b88427a155a1f495861d9 0000-0003-0173-8843 Helen Snooks Helen Snooks true false 2018-07-06 HDAT BackgroundComputerised clinical decision support (CCDS) has been shown to improve processes of care in some healthcare settings, but there is little evidence related to its use or effects in pre-hospital emergency care. CCDS in this setting aligns with policies to increase IT use in ambulance care, enhance paramedic decision-making skills, reduce avoidable emergency department attendances and improve quality of care and patient experience. This qualitative study was conducted alongside a cluster randomised trial in two ambulance services of the costs and effects of web-based CCDS system designed to support paramedic decision-making in the care of older people following a fall. Paramedics were trained to enter observations and history for relevant patients on a tablet, and the CCDS then generated a recommended course of action which could be logged. Our aim was to describe paramedics’ experience of the CCDS intervention and to identify factors affecting its implementation and use.MethodsWe invited all paramedics who had been randomly allocated to the intervention arm of the trial to participate in interviews or focus groups. The study was underpinned by Strong Structuration Theory, a theoretical model for studying innovation based on the relationship between what people do and their context. We used the Framework approach to data analysis.ResultsTwenty out of 22 paramedics agreed to participate. We developed a model of paramedic experience of CCDS with three domains: context, adoption and use, and outcomes. Aspects of context which had an impact included organisational culture and perceived support for non-conveyance decisions. Experience of adoption and use of the CCDS varied between individual paramedics, with some using it with all eligible patients, some only with patients they thought were ‘suitable’ and some never using it. A range of outcomes were reported, some of which were different from the intended role of the technology in decision support.ConclusionImplementation of new technology such as CCDS is not a one-off event, but an ongoing process, which requires support at the organisational level to be effective.Trial registrationISRCTN Registry 10538608. Registered 1 May 2007. Retrospectively registered. Journal Article Implementation Science 13 1 Springer Science and Business Media LLC 1748-5908 4 7 2018 2018-07-04 10.1186/s13012-018-0786-x COLLEGE NANME Health Data Science COLLEGE CODE HDAT Swansea University The authors would like to thank the Department of Health ICTRI2 research programme for funding the SAFER 1 study and the Wales Office for Research and Development in health and social care for funding this element of the study through a PhD studentship grant. 2022-11-11T15:10:07.4317490 2018-07-06T12:05:44.9807825 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Alison Porter 0000-0002-3408-7007 1 Jeremy Dale 2 Theresa Foster 3 Pip Logan 4 Bridget Wells 5 Helen Snooks 0000-0003-0173-8843 6 0040947-24072018112855.pdf 40947.pdf 2018-07-24T11:28:55.0800000 Output 789888 application/pdf Version of Record true 2018-07-24T00:00:00.0000000 This article is distributed under the terms of the Creative Commons Attribution 4.0 International License. true eng http://creativecommons.org/licenses/by/4.0/
title Implementation and use of computerised clinical decision support (CCDS) in emergency pre-hospital care: a qualitative study of paramedic views and experience using Strong Structuration Theory
spellingShingle Implementation and use of computerised clinical decision support (CCDS) in emergency pre-hospital care: a qualitative study of paramedic views and experience using Strong Structuration Theory
Alison Porter
Bridget Wells
Helen Snooks
title_short Implementation and use of computerised clinical decision support (CCDS) in emergency pre-hospital care: a qualitative study of paramedic views and experience using Strong Structuration Theory
title_full Implementation and use of computerised clinical decision support (CCDS) in emergency pre-hospital care: a qualitative study of paramedic views and experience using Strong Structuration Theory
title_fullStr Implementation and use of computerised clinical decision support (CCDS) in emergency pre-hospital care: a qualitative study of paramedic views and experience using Strong Structuration Theory
title_full_unstemmed Implementation and use of computerised clinical decision support (CCDS) in emergency pre-hospital care: a qualitative study of paramedic views and experience using Strong Structuration Theory
title_sort Implementation and use of computerised clinical decision support (CCDS) in emergency pre-hospital care: a qualitative study of paramedic views and experience using Strong Structuration Theory
author_id_str_mv fcc861ec479a79f7fb9befb13192238b
c7b87b8f9a9c4785e14ec3d506c5f185
ab23c5e0111b88427a155a1f495861d9
author_id_fullname_str_mv fcc861ec479a79f7fb9befb13192238b_***_Alison Porter
c7b87b8f9a9c4785e14ec3d506c5f185_***_Bridget Wells
ab23c5e0111b88427a155a1f495861d9_***_Helen Snooks
author Alison Porter
Bridget Wells
Helen Snooks
author2 Alison Porter
Jeremy Dale
Theresa Foster
Pip Logan
Bridget Wells
Helen Snooks
format Journal article
container_title Implementation Science
container_volume 13
container_issue 1
publishDate 2018
institution Swansea University
issn 1748-5908
doi_str_mv 10.1186/s13012-018-0786-x
publisher Springer Science and Business Media LLC
college_str Faculty of Medicine, Health and Life Sciences
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hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
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description BackgroundComputerised clinical decision support (CCDS) has been shown to improve processes of care in some healthcare settings, but there is little evidence related to its use or effects in pre-hospital emergency care. CCDS in this setting aligns with policies to increase IT use in ambulance care, enhance paramedic decision-making skills, reduce avoidable emergency department attendances and improve quality of care and patient experience. This qualitative study was conducted alongside a cluster randomised trial in two ambulance services of the costs and effects of web-based CCDS system designed to support paramedic decision-making in the care of older people following a fall. Paramedics were trained to enter observations and history for relevant patients on a tablet, and the CCDS then generated a recommended course of action which could be logged. Our aim was to describe paramedics’ experience of the CCDS intervention and to identify factors affecting its implementation and use.MethodsWe invited all paramedics who had been randomly allocated to the intervention arm of the trial to participate in interviews or focus groups. The study was underpinned by Strong Structuration Theory, a theoretical model for studying innovation based on the relationship between what people do and their context. We used the Framework approach to data analysis.ResultsTwenty out of 22 paramedics agreed to participate. We developed a model of paramedic experience of CCDS with three domains: context, adoption and use, and outcomes. Aspects of context which had an impact included organisational culture and perceived support for non-conveyance decisions. Experience of adoption and use of the CCDS varied between individual paramedics, with some using it with all eligible patients, some only with patients they thought were ‘suitable’ and some never using it. A range of outcomes were reported, some of which were different from the intended role of the technology in decision support.ConclusionImplementation of new technology such as CCDS is not a one-off event, but an ongoing process, which requires support at the organisational level to be effective.Trial registrationISRCTN Registry 10538608. Registered 1 May 2007. Retrospectively registered.
published_date 2018-07-04T03:47:06Z
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