The data quality and applicability of a Danish prehospital electronic health record: A mixed-methods study

Jeannett Kjær; Louise Milling; Daniel Wittrock; Lars Bak Nielsen; Søren Mikkelsen

doi:10.1371/journal.pone.0293577

The data quality and applicability of a Danish prehospital electronic health record: A mixed-methods study

Jeannett Kjær^*
, Louise Milling
, Daniel Wittrock
, Lars Bak Nielsen
, Søren Mikkelsen

^*Corresponding author for this work

Responce, Kolding

Research output: Contribution to journal › Journal article › Research › peer-review

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Abstract

BACKGROUND: Without accurate documentation, it can be difficult to assess the quality of care and the impact of quality improvement initiatives. Prehospital lack of documentation of the basic measurements is associated with a twofold risk of mortality. The aim of this study was to investigate data quality in the electronic prehospital patient record (ePPR) system in the Region of Southern Denmark. In addition, we investigated ambulance professionals' attitudes toward the use of ePPR and identified barriers and facilitators to its use.

METHOD: We used an explanatory sequential mixed-methods design. Phase one consisted of a retrospective assessment of the data quality of ePPR information, and phase two included semi-structured interviews with ambulance professionals combined with observations. We included patients who were acutely transported to an emergency department by ambulance in the Region of Southern Denmark from 2016 to 2020. Data completeness was calculated for each vital sign using a two-way table of frequency. Vital signs were summarised to calculate data correctness. Interviews and observations were analysed using thematic analysis.

RESULTS: Overall, an improvement in data completeness and correctness was observed from 2016-2020. When stratified by age group, children (<12 years) accounted for the majority of missing vital sign registrations. In the thematic analysis, we identified four themes; ambulance professionals' attitudes, emergency setting, training and guidelines, and tablet and software.

CONCLUSION: We found high data quality, but there is room for improvement. The ambulance professionals' attitudes toward the ePPR, working in an emergency setting, a notion of insufficient training in completing the ePPR, and challenges related to the tablet and software could be barriers to data completeness and correctness. It would be beneficial to include the end-user when developing an ePPR system and to consider that the tablet should be used in emergency situations.

Original language	English
Article number	e0293577
Journal	PLOS ONE
Volume	18
Issue number	10
Number of pages	20
ISSN	1932-6203
DOIs	https://doi.org/10.1371/journal.pone.0293577
Publication status	Published - 26. Oct 2023

Bibliographical note

Publisher Copyright:
© 2023 Kjær et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding

We would like to thank the ambulance professionals in the Region of Southern Denmark for participating in the interviews. Furthermore, we thank the Emergency Medical Service, Region of Southern Denmark, and Response A/S for giving access to the ambulance stations. Finally, we will thank Jesper Høgh Bager, KMD, who assisted in extracting the EHR data.

Keywords

Ambulances
Child
Data Accuracy
Denmark
Electronic Health Records
Emergency Medical Services
Humans
Retrospective Studies
Tablets

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title = "The data quality and applicability of a Danish prehospital electronic health record: A mixed-methods study",

abstract = "BACKGROUND: Without accurate documentation, it can be difficult to assess the quality of care and the impact of quality improvement initiatives. Prehospital lack of documentation of the basic measurements is associated with a twofold risk of mortality. The aim of this study was to investigate data quality in the electronic prehospital patient record (ePPR) system in the Region of Southern Denmark. In addition, we investigated ambulance professionals' attitudes toward the use of ePPR and identified barriers and facilitators to its use.METHOD: We used an explanatory sequential mixed-methods design. Phase one consisted of a retrospective assessment of the data quality of ePPR information, and phase two included semi-structured interviews with ambulance professionals combined with observations. We included patients who were acutely transported to an emergency department by ambulance in the Region of Southern Denmark from 2016 to 2020. Data completeness was calculated for each vital sign using a two-way table of frequency. Vital signs were summarised to calculate data correctness. Interviews and observations were analysed using thematic analysis.RESULTS: Overall, an improvement in data completeness and correctness was observed from 2016-2020. When stratified by age group, children (<12 years) accounted for the majority of missing vital sign registrations. In the thematic analysis, we identified four themes; ambulance professionals' attitudes, emergency setting, training and guidelines, and tablet and software.CONCLUSION: We found high data quality, but there is room for improvement. The ambulance professionals' attitudes toward the ePPR, working in an emergency setting, a notion of insufficient training in completing the ePPR, and challenges related to the tablet and software could be barriers to data completeness and correctness. It would be beneficial to include the end-user when developing an ePPR system and to consider that the tablet should be used in emergency situations.",

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note = "Publisher Copyright: {\textcopyright} 2023 Kj{\ae}r et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

year = "2023",

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T2 - A mixed-methods study

AU - Kjær, Jeannett

AU - Milling, Louise

AU - Wittrock, Daniel

AU - Nielsen, Lars Bak

AU - Mikkelsen, Søren

N1 - Publisher Copyright: © 2023 Kjær et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2023/10/26

Y1 - 2023/10/26

N2 - BACKGROUND: Without accurate documentation, it can be difficult to assess the quality of care and the impact of quality improvement initiatives. Prehospital lack of documentation of the basic measurements is associated with a twofold risk of mortality. The aim of this study was to investigate data quality in the electronic prehospital patient record (ePPR) system in the Region of Southern Denmark. In addition, we investigated ambulance professionals' attitudes toward the use of ePPR and identified barriers and facilitators to its use.METHOD: We used an explanatory sequential mixed-methods design. Phase one consisted of a retrospective assessment of the data quality of ePPR information, and phase two included semi-structured interviews with ambulance professionals combined with observations. We included patients who were acutely transported to an emergency department by ambulance in the Region of Southern Denmark from 2016 to 2020. Data completeness was calculated for each vital sign using a two-way table of frequency. Vital signs were summarised to calculate data correctness. Interviews and observations were analysed using thematic analysis.RESULTS: Overall, an improvement in data completeness and correctness was observed from 2016-2020. When stratified by age group, children (<12 years) accounted for the majority of missing vital sign registrations. In the thematic analysis, we identified four themes; ambulance professionals' attitudes, emergency setting, training and guidelines, and tablet and software.CONCLUSION: We found high data quality, but there is room for improvement. The ambulance professionals' attitudes toward the ePPR, working in an emergency setting, a notion of insufficient training in completing the ePPR, and challenges related to the tablet and software could be barriers to data completeness and correctness. It would be beneficial to include the end-user when developing an ePPR system and to consider that the tablet should be used in emergency situations.

AB - BACKGROUND: Without accurate documentation, it can be difficult to assess the quality of care and the impact of quality improvement initiatives. Prehospital lack of documentation of the basic measurements is associated with a twofold risk of mortality. The aim of this study was to investigate data quality in the electronic prehospital patient record (ePPR) system in the Region of Southern Denmark. In addition, we investigated ambulance professionals' attitudes toward the use of ePPR and identified barriers and facilitators to its use.METHOD: We used an explanatory sequential mixed-methods design. Phase one consisted of a retrospective assessment of the data quality of ePPR information, and phase two included semi-structured interviews with ambulance professionals combined with observations. We included patients who were acutely transported to an emergency department by ambulance in the Region of Southern Denmark from 2016 to 2020. Data completeness was calculated for each vital sign using a two-way table of frequency. Vital signs were summarised to calculate data correctness. Interviews and observations were analysed using thematic analysis.RESULTS: Overall, an improvement in data completeness and correctness was observed from 2016-2020. When stratified by age group, children (<12 years) accounted for the majority of missing vital sign registrations. In the thematic analysis, we identified four themes; ambulance professionals' attitudes, emergency setting, training and guidelines, and tablet and software.CONCLUSION: We found high data quality, but there is room for improvement. The ambulance professionals' attitudes toward the ePPR, working in an emergency setting, a notion of insufficient training in completing the ePPR, and challenges related to the tablet and software could be barriers to data completeness and correctness. It would be beneficial to include the end-user when developing an ePPR system and to consider that the tablet should be used in emergency situations.

KW - Ambulances

KW - Child

KW - Data Accuracy

KW - Denmark

KW - Electronic Health Records

KW - Emergency Medical Services

KW - Humans

KW - Retrospective Studies

KW - Tablets

U2 - 10.1371/journal.pone.0293577

DO - 10.1371/journal.pone.0293577

M3 - Journal article

C2 - 37883522

AN - SCOPUS:85175275233

SN - 1932-6203

VL - 18

JO - PLOS ONE

JF - PLOS ONE

IS - 10

M1 - e0293577

ER -

The data quality and applicability of a Danish prehospital electronic health record: A mixed-methods study

Abstract

Bibliographical note

Funding

Keywords

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