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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

Abstract

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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Published: 2013
Institution: Swansea University
Degree level: Doctoral
Degree name: Ph.D
URI: https://cronfa.swan.ac.uk/Record/cronfa43112
first_indexed 2018-08-02T18:56:18Z
last_indexed 2019-10-21T16:49:03Z
id cronfa43112
recordtype RisThesis
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spelling 2018-08-29T15:42:29.6654071 v2 43112 2018-08-02 Implementation of computerised clinical decision support (CCDS) in a prehospital setting: Processes of adoption and impact on paramedic role and practice. dfb3cd2d4ba549ba1c387ec44885e308 NULL Bridget Wells Bridget Wells true true 2018-08-02 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. E-Thesis Emergency medical technicians 31 12 2013 2013-12-31 COLLEGE NANME Swansea University Medical School COLLEGE CODE Swansea University Doctoral Ph.D 2018-08-29T15:42:29.6654071 2018-08-02T16:24:31.3034091 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Bridget Wells NULL 1 0043112-02082018162547.pdf 10821504.pdf 2018-08-02T16:25:47.5570000 Output 9814979 application/pdf E-Thesis true 2018-08-02T16:25:47.5570000 false
title Implementation of computerised clinical decision support (CCDS) in a prehospital setting: Processes of adoption and impact on paramedic role and practice.
spellingShingle Implementation of computerised clinical decision support (CCDS) in a prehospital setting: Processes of adoption and impact on paramedic role and practice.
Bridget Wells
title_short Implementation of computerised clinical decision support (CCDS) in a prehospital setting: Processes of adoption and impact on paramedic role and practice.
title_full Implementation of computerised clinical decision support (CCDS) in a prehospital setting: Processes of adoption and impact on paramedic role and practice.
title_fullStr Implementation of computerised clinical decision support (CCDS) in a prehospital setting: Processes of adoption and impact on paramedic role and practice.
title_full_unstemmed Implementation of computerised clinical decision support (CCDS) in a prehospital setting: Processes of adoption and impact on paramedic role and practice.
title_sort Implementation of computerised clinical decision support (CCDS) in a prehospital setting: Processes of adoption and impact on paramedic role and practice.
author_id_str_mv dfb3cd2d4ba549ba1c387ec44885e308
author_id_fullname_str_mv dfb3cd2d4ba549ba1c387ec44885e308_***_Bridget Wells
author Bridget Wells
author2 Bridget Wells
format E-Thesis
publishDate 2013
institution Swansea University
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 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.
published_date 2013-12-31T07:32:27Z
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