title: The effect of a Computerised Decision Support System (CDSS) on compliance with the prehospital assessment process: results of an interrupted time-series study.
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.
authors.affiliation: University of Borås, School of Health Sciences, 501 90 Borås, Sweden. magnus.hagiwara@hb.se.
authors.forename: Magnus
authors.initials: M
authors.lastname: Andersson Hagiwara
authors.forename: Björn-Ove
authors.initials: BO
authors.lastname: Suserud
authors.forename: Boel
authors.initials: B
authors.lastname: Andersson-Gäre
authors.forename: Bengt- Arne
authors.initials: B
authors.lastname: Sjöqvist
authors.forename: Maria
authors.initials: M
authors.lastname: Henricson
authors.forename: Anders
authors.initials: A
authors.lastname: Jonsson
mesh_terms: D000328:Adult; D020000:Decision Support Systems, Clinical / Q000592:standards*; D004632:Emergency Medical Services / Q000592:standards*; D005103:Expert Systems; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D065186:Interrupted Time Series Analysis; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D063189:Symptom Assessment / Q000592:standards*
references.citation: J Biomed Inform. 2002 Feb;35(1):52-75
references.pmid: 12415726
references.citation: Int J Cardiol. 2008 Oct 13;129(3):325-32
references.pmid: 17997494
references.citation: J Clin Pharm Ther. 2002 Aug;27(4):299-309
references.pmid: 12174032
references.citation: Scand J Trauma Resusc Emerg Med. 2013 Jun 22;21:46
references.pmid: 23799944
references.citation: Acad Emerg Med. 2007 Nov;14(11):1052-7
references.pmid: 17761547
references.citation: Tech Vasc Interv Radiol. 2005 Jun;8(2):74-80
references.pmid: 16194754
references.citation: Pediatr Emerg Care. 1995 Aug;11(4):217-9
references.pmid: 8532565
references.citation: Qual Saf Health Care. 2002 Mar;11(1):40-4
references.pmid: 12078368
references.citation: Prehosp Emerg Care. 2005 Jan-Mar;9(1):2-7
references.pmid: 16036820
references.citation: Prehosp Emerg Care. 2012 Jan-Mar;16(1):86-97
references.pmid: 22023164
references.citation: BMJ Qual Saf. 2011 Apr;20 Suppl 1:i18-23
references.pmid: 21450764
references.citation: Implement Sci. 2011 Aug 03;6:91
references.pmid: 21824385
references.citation: J Burn Care Res. 2010 Jan-Feb;31(1):121-4
references.pmid: 20061846
references.citation: Prehosp Emerg Care. 2010 Jan-Mar;14(1):95-102
references.pmid: 19947873
references.citation: CJEM. 2011 Sep;13(5):310-8
references.pmid: 21955412
references.citation: Implement Sci. 2010 May 26;5:38
references.pmid: 20504293
references.citation: J Am Med Inform Assoc. 2000 Nov-Dec;7(6):569-85
references.pmid: 11062231
references.citation: Emerg Med J. 2008 Jul;25(7):444-9
references.pmid: 18573968
references.citation: Accid Emerg Nurs. 2007 Jan;15(1):27-33
references.pmid: 17218102
references.citation: Prehosp Disaster Med. 2011 Oct;26(5):319-29
references.pmid: 22030101
references.citation: Int J Technol Assess Health Care. 2003 Fall;19(4):613-23
references.pmid: 15095767
references.citation: Am J Surg. 2009 Jan;197(1):30-4
references.pmid: 18558397
references.citation: Prehosp Emerg Care. 2010 Oct-Dec;14(4):448-60
references.pmid: 20809688
references.citation: Ann Emerg Med. 2013 Oct;62(4):367-79
references.pmid: 23787209
references.citation: Fam Med. 2005 May;37(5):360-3
references.pmid: 15883903
references.citation: CJEM. 2011 Jan;13(1):13-8
references.pmid: 21324292
references.citation: J Biomed Inform. 2011 Dec;44(6):943-7
references.pmid: 21763459
references.citation: BMJ. 2005 Apr 2;330(7494):765
references.pmid: 15767266
references.citation: J Clin Epidemiol. 2011 Nov;64(11):1252-61
references.pmid: 21640554
references.citation: BMJ. 2000 Sep 16;321(7262):694-6
references.pmid: 10987780
references.citation: Am J Emerg Med. 2013 Jan;31(1):145-53
references.pmid: 23000323
references.citation: J Int Med Res. 2011;39(1):267-76
references.pmid: 21672330
references.citation: Emerg Med J. 2001 Nov;18(6):478-81
references.pmid: 11696508
references.citation: Med Care Res Rev. 2010 Oct;67(5):503-27
references.pmid: 20150441
references.citation: Prehosp Emerg Care. 2012 Jan-Mar;16(1):3-19
references.pmid: 22023217
references.citation: Qual Saf Health Care. 2010 Aug;19 Suppl 2:i25-33
references.pmid: 20693213
references.citation: Int J Med Inform. 2005 Dec;74(11-12):869-85
references.pmid: 16087392