Electronic Prehospital Records are Often Unavailable for Emergency Department Medical Decision Making

Bledsoe, Bryan E; Wasden, Chad; Johnson, Larry

doi:10.5811/westjem.2013.1.12665

Cited by 16 publications

(19 citation statements)

References 17 publications

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“…These benefits correlate with the findings of others that use of EMR provides benefits in the emergency medical services setting for paramedics, ambulance services, and academia (Bledsoe et al, 2013;Katzer et al, 2012;Newgard et al, 2012).…”

Section: Discussionsupporting

confidence: 77%

“…Eighty-nine percent of hospital emergency department physicians surveyed in the United States reported that the paramedics' written medical chart was important or very important to their emergency department medical practice. Those same physicians overwhelmingly preferred an electronic record to a hand written chart, 52% vs. 17% (Bledsoe et al, 2013).…”

Section: Changing Systems and Processesmentioning

confidence: 99%

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Leading change: introducing an electronic medical record system to a paramedic service

Baird¹,

Boak

2016

LHS

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(2016) Leading change: introducing an electronic medical record system to a paramedic service. Leadership in Health Services, 29 (2). pp. 136-150. The adoption use of EMR by in the emergency medical and ambulance setting is expected to provide across the health sector is a significant innovation providing wide-ranging benefits, but there is little research into processes of adoption in this sector. it remains little studied especially in the emergency medical and ambulance setting. This study examines the introduction of EMR in a small emergency care organization, and identifies factors that aided adoption. Design/methodology/approachSemi-structured interviews with selected paramedics were followed up with a survey issued to all paramedics in the company. FindingsThe user interface with the EMR, and perceived ease of use, were important factors affecting adoption. Additionally, Individual paramedics were found to have strong and varied preferences about how and when they integrated the EMR into their practice. As company leadership introduced multiple modes of access, resistance to the system decreased. Permitting flexibility of use, this enhanced both individual and collective ability to make sense of the significant technology change and removed barriers to acceptance. Research limitations/implicationsThis is a case study of one small organization. However, there may be useful lessons for other emergency care organizations adopting EMR. Practical implicationsPractical lessons are indicated for Leaders introducing EMR in similar situations may benefit from considering a sensemaking perspective, and responding promptly to feedback. Originality/valueThe study's findings were supportive of findings in a review of relevant, but limited, literature on the mandatory use of electronic medical records. By extending into a novel setting, that of paramedics out-of-hospital, The study contributes to a wider understanding of issues facing leaders those who seek to implement electronic

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Section: Discussionsupporting

confidence: 77%

Section: Changing Systems and Processesmentioning

confidence: 99%

Leading change: introducing an electronic medical record system to a paramedic service

Baird¹,

Boak

2016

LHS

View full text Add to dashboard Cite

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“…A large survey of the American College of Emergency Physicians (ACEP) physicians demonstrated that 89% of physicians felt that prehospital records were either "very important" or "important" to their ED practice, but were usually unavailable at the time of medical decision-making. 12 In keeping with this finding, 81.1% of patients in our study did not have an ACR available to the treating physician at the time of initial assessment, and 69.5% did not have an ACR available at any point during ED care. This finding is contrary to the NAEMSP position that the complete EMS patient care report must be made available to the receiving facility within a clinically relevant period of time.…”

Section: Discussionsupporting

confidence: 51%

“…While previous research has demonstrated the general value of the ACR, and the fact that physicians perceive the ACR as an important tool, we were able to show that physicians believed that the ACR changed management in 28.8% of specific patient encounters. 11,12 In our study, physicians did not receive an ACR or verbal handover from a nurse or paramedic in half of patients (50.5%), highlighting the possible loss of valuable prehospital information, which could result in improper or inadequate workups, treatments, and disposition decisions. Although physicians regard prehospital information from paramedics as relevant and important to patient care, handover is often incomplete.…”

Section: Discussionmentioning

confidence: 99%

“…However, paper ACRs have their own intrinsic drawbacks such as poor legibility, the risk of losing the paper hard copy, and need for manual delivery to the hospital after completion. 12 Additionally, in our system, there are human factors and errors involved with ED clerical staff being responsible for retrieving the faxed ACRs from the printer and adding them to the patient chart in a timely manner. The ideal ACR delivery system would likely involve an eACR that could be uploaded to the patient's e-health record system and viewed by the treating physician in real-time.…”

Section: Limitationsmentioning

confidence: 99%

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A prospective evaluation of the availability and utility of the Ambulance Call Record in the emergency department

Cram

McLeod

Lewell

et al. 2016

CJEM

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Objective: To determine how often the Ambulance Call Record (ACR) was available to emergency department (ED) physicians and whether it contained information that changed the ED management of patients. Methods: This was a prospective cohort study of adult patients transported to one of two tertiary care centre EDs. Physicians completed a data collection form for each patient regarding ACR availability and the perceived value of the ACR. This study began shortly after the implementation of a new electronic ACR (eACR) handover process (Round 1). To control for any confounding factors related to this new eACR handover process, the study was repeated 6 months after its implementation (Round 2). Results: Total of 869 forms were collected: 545 in Round 1, and 324 in Round 2. The ACR was available at first physician assessment for 82 (15.7%) patients in Round 1, and 76 (24.4%) patients in Round 2 (Δ8.7%, 95% CI: 3.1%, 14.5%). The ACR was available at some point during patients' ED stay for 154 (28.9%) patients in Round 1, compared to 111 (34.5%) patients in Round 2 (Δ5.6%, 95% CI: 0.0%, 12.1%). When the ACR was available for a patient (n = 265), physicians believed that information in the ACR changed their treatment plan in 76 (28.8%) cases. Conclusion: Physicians who review the ACR believe that the ACR contains relevant information that may influence patient management; however, physicians commonly manage patients without reviewing the ACR. RÉSUMÉObjectifs: L'étude visait à déterminer dans quelle mesure les enregistreurs d'appels d'ambulance (EAA) étaient à la disposition des médecins et si les renseignements fournis influaient sur le traitement des patients au service des urgences (SU). Méthode: Il s'agit d'une étude de cohorte prospective, composée d'adultes transportés à l'un des deux SU de soins tertiaires. Les médecins ont rempli, pour chacun des malades, un formulaire de collecte de données relativement à la présence ou non d'un EAA et à la perception de la valeur de ce type d'appareil. L'étude a commencé peu de temps après la mise en oeuvre d'un processus de transfert de soins à l'aide d'un nouvel EAA électronique (1 re étape). Six mois après la mise en oeuvre du processus de transfert de soins (2 e étape), l'étude a été reprise afin que soit éliminé tout facteur parasite lié à l'utilisation du nouvel EAA électronique.Résultats: Au total, 869 formulaires ont été recueillis : 545 au cours de la 1 re étape et 324 au cours de la 2 e étape. Un EAA était disponible à la première évaluation médicale de 82 (15,7 %) patients au cours de la 1 re étape et de 76 (24,4 %) patients au cours de la 2 e étape (écart [Δ] 8,7 %; IC à 95 % : 3,1 %-14,5 %).Par ailleurs, les médecins avaient la possibilité d'écouter l'EAA à tout moment durant le séjour des patients au SU dans 154 (28,9 %) cas au cours de la 1 re étape et dans 111 (34,5 %) cas au cours de la 2 e étape (Δ 5,6 %; IC à 95 % : 0,0 %-12,1 %). Enfin, les médecins étaient d'avis que, lorsqu'il était possible d'écouter les EAA (n = 265), les renseignements fournis av...

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The Effects of Integrated IT Support on the Prehospital Stroke Process: Results from a Realistic Experiment

Hagiwara

Lundberg

Sjöqvist

et al. 2019

J Healthc Inform Res

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Stroke is a serious condition and the stroke chain of care is a complex. The present study aims to explore the impact of a computerised decision support system (CDSS) for the prehospital stroke process, with focus on work processes and performance. The study used an exploratory approach with a randomised controlled crossover design in a realistic contextualised simulation experiment. The study compared clinical performance among 11 emergency medical services (EMS) teams of 22 EMS clinicians using (1) a computerised decision support system (CDSS) and (2) their usual paper-based process support. Data collection consisted of video recordings, postquestionnaires and post-interviews, and data were analysed using a combination of qualitative and quantitative approaches. In this experiment, using a CDSS improved patient assessment, decision making and compliance to process recommendations. Minimal impact of the CDSS was found on EMS clinicians' self-efficacy, suggesting that even though the system was found to be cumbersome to use it did not have any negative effects on selfefficacy. Negative effects of the CDSS include increased on-scene time and a cognitive burden of using the system, affecting patient interaction and collaboration with team members. The CDSS's overall process advantage to the prehospital stroke process is assumed to lead to a prehospital care that is both safer and of higher quality. The key to user acceptance of a system such as this CDSS is the relative advantages of improved documentation process and the resulting patient journal. This could improve the overall prehospital stroke process.

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Electronic Prehospital Records are Often Unavailable for Emergency Department Medical Decision Making

Cited by 16 publications

References 17 publications

Leading change: introducing an electronic medical record system to a paramedic service

Leading change: introducing an electronic medical record system to a paramedic service

A prospective evaluation of the availability and utility of the Ambulance Call Record in the emergency department

The Effects of Integrated IT Support on the Prehospital Stroke Process: Results from a Realistic Experiment

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