Implementation and Evaluation of the Stroke Triage App Among Paramedics in Prehospital Emergency Care: Sequential Mixed Methods Study
Journal of Medical Internet Research ·
Background: Digital decision-support tools, such as the Stroke Triage App (STA), may enhance prehospital triage and clinical decision-making for suspected patients with stroke. However, implementation of decision-support tools and their impact on clinical practice remains insufficiently studied. Objective: This study aimed to investigate paramedics’ experiences with the implementation of the STA in prehospital practice by evaluating the implementation process, the implementation outcomes, and its impact on clinical workflows, while considering contextual factors that may have influenced these dimensions. Methods: STA implementation was evaluated among paramedics in 2 emergency medical services regions in the Netherlands using a sequential mixed methods approach. Actual usage data were extracted from the STA dashboard. Usability, perceived impact, and contextual factors were explored using an online survey and semistructured interviews. Results: Monthly triages ranged from 52 to 153 (median 120, IQR 107‐131). Paramedics’ individual STA use ranged from 1 to 47 times (median 7, IQR 3‐13). Out of 246 paramedics with an account, 76 (31%) completed the survey, and 9 (4%) participated in semistructured interviews. The STA was generally well accepted, supporting structured neurological assessment and communication. Swift technical support, frequent promotion, and use of local ambassadors facilitated STA use. Clinical urgency, poor workflow integration, and limited perceived added value hampered STA use. Users recommended improvements in mobile interface, login features, and additional explanation with triage advice. Conclusions: This study demonstrates that the STA achieved substantial reach and initial adoption within the prehospital setting. However, widespread acceptance did not consistently translate into routine integration in daily practice. Successful implementation depends as much on addressing organizational and human factors as on technical performance.