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Implementation of computerised clinical decision support (CCDS) in a prehospital setting: Processes of adoption and impact on paramedic role and practice. / Bridget, Wells
Swansea University Author: Bridget, Wells
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TitleImplementation of computerised clinical decision support (CCDS) in a prehospital setting: processes of adoption and impact on paramedic role and practiceAimTo examine the adoption of CCDS by paramedics, including the impact of CCDS on paramedic role and practice.MethodsSystematic review of CCDS...
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TitleImplementation of computerised clinical decision support (CCDS) in a prehospital setting: processes of adoption and impact on paramedic role and practiceAimTo examine the adoption of CCDS by paramedics, including the impact of CCDS on paramedic role and practice.MethodsSystematic review of CCDS in emergency care followed by a cluster-randomised controlled trial (C-RCT) of CCDS with a qualitative component involving 42 paramedics at two study sites.Results19/20 studies identified for inclusion in the systematic review were from the Emergency Department setting, with no studies from prehospital care. The focus of the studies was on process of care (19/20) rather than patient outcomes (5/20). Positive impacts were reported in 15/19 (79%) process of care studies. Only two patient outcome studies were able to report findings (one positive, one negative). Results relating to CCDS implementation were reported as an ad hoc response to problems encountered. In this C-RCT paramedics used CCDS with 12% of eligible patients (site one: 2%; site two: 24%). Intervention paramedics were twice as likely to refer patients to a falls service as those in the control group (usual care) (relative risk = 2.0; 95% Cl 1.1 to 3.7) although conveyance rates were unaltered (relative risk = 1.1; 95% Cl 0.8 to 1.5) and episode of care was unchanged (-5.7 minutes; 95% Cl -38.5 to 27.2). When CCDS was used patient referral to falls services was three times as likely (relative risk = 3.1; 95% Cl 1.4 to 6.9), and non-conveyance was twice as likely (risk = 2.1; 95% Cl 1.1 to 3.9) and overall episode of care fell by 114 minutes (95% Cl from 77.2 to 150.3). Reasons given for not using CCDS included technical problems, lack of integration, it was not sophisticated enough to influence decision making. Paramedics adapted when and how they used CCDS to suit context and patient condition.ConclusionThere is little existing evidence in relation to CCDS use in the emergency care setting, and the prehospital emergency care setting in particular. Studies of CCDS undertaken in emergency departments have shown benefit, particularly in relation to process of care. The C-RCT found that CCDS use by paramedics was low, particularly at site one, but use was associated with higher rates of patient referral and non-conveyance, and shorter episodes of care. There were encouraging signs that CCDS can support a new decision making role for paramedics. The study provides useful lessons for policy makers, practitioners and researchers about the potential benefits of CCDS and the challenges to adoption of new technology in emergency prehospital care.
Emergency medical technicians
Swansea University Medical School