New technology for safer emergency medical services

Magnus Hagiwara has worked for many years as an ambulance nurse in Borås. In recent years he has conducted research at PreHospen at the University of Borås and at the School of Health Sciences at Jönköping University.

“I started researching in 2010 and then did a systematic literature review,” says Magnus Hagiwara. It then turned out that there was not a single study in the world that had examined computerised decision support for prehospital care.

Part of the research was to test digital decision support developed in collaboration with a medical device company. In the trial, 30 ambulance nurses had to take care of two simulated patient cases in the usual way while 30 performed this with the help of decision support.

The digital decision support was located in a device that looked like a slightly thicker i-Pad. Here the nurses clicked in what they were doing with the patient, and then received different types of feedback: control questions, alternative diagnoses, instructions on further action, etc.

Followed guidelines

“Here we could see that the guidelines were followed to a far greater extent when decision support was used,” says Magnus Hagiwara. Adherence was 60 per cent for those who worked in the usual way. Those who used the digital decision support followed the guidelines to 80 per cent. However, they worked slightly slower, which is also important to take into consideration.

Magnus Hagiwara has linked his results to several different theories, based on patient safety. One of the theories addresses misjudgements. This is something that previous studies has shown to be the greatest threat to patient safety, and is therefore something that you need to minimise.

“There are models to identify how you can minimise errors of judgement, which may be due to many different factors. The working hours of staff, equipment and others”. It is fundamental to realise that people make mistakes, and to try to build a defensive layer against these errors. One of the reasons that errors occur is that the guidelines and decision support are not good enough. This points to a possible need for a new, digital decision support. Checklists are also considered to be important.

"This is just a start"

In summary, you can say that Magnus Hagiwara has concluded that the benefits of a digital decision support may be that you follow a process of assessment, that it can be used as a checklist, that record keeping begins immediately and, for example, it can ask counter questions.

“I want to emphasise that this is just a start,” says Magnus Hagiwara. Many questions remain, for example, about how the implementation of a decision support system would take place and how to manage data security issues. “I will now continue to mix teaching and research positions with ambulance work. I hope to then be able to continue my research into decision-making, judgement and cognition. It is a very interesting area”.

The thesis is entitled “Development and Evaluation of a Computerised Decision Support System for use in pre-hospital care”.