Introduction
In high-risk, time-sensitive medical domains, such as emergency care, medical professionals must provide rapid treatment and manage potentially life-threatening illnesses or injuries (e.g., trauma injuries, stroke, medication overdose). Effective and timely information sharing between pre-hospital and hospital providers (also known as prehospital communication) is a critical first step for achieving this goal1. Information collected in the field and en route to the hospital (pre-hospital information) can help the emergency care providers at the receiving hospital anticipate the severity of patient illness or injury, and make appropriate preparations and triage decisions2. Despite its critical role, information sharing between the field providers and those at the receiving hospital remains challenging3, 4. For example, verbal reports given by pre-hospital providers during patient transport often lack detail5, 6 or accuracy7, 8, making it difficult for hospital teams to appropriately prepare. The highly dynamic nature of out-of-hospital encounters is also characterized by frequent interruptions, posing challenges on real-time data collection and leading to delayed and incomplete information dissemination from the field9, 10.
Previous research has developed information and communication technologies (ICTs) to support data transfer from the field to receiving hospitals11, 12. Key examples include mobile electronic documentation systems10, 13 and ambulance-based telemedicine systems14-19. These systems, however, are rarely used in real-time due to portability and usability issues15, 19, 20. Pre-hospital providers have to perform hands-on examinations and treatments on patients while managing information from multiple sources in short time periods. This work practice limits their direct interaction with handheld systems21. Prior research has highlighted that the development of ICTs for healthcare professionals should not only focus on technological aspects but also account for user needs and current work practices3, 12. Although several studies have looked at information handover workflow between pre-hospital and hospital teams in the receiving care centers (e.g., emergency department)5, 8, 9, 22, limited research exists on the ways in which pre-hospital information is collected and shared in the field.
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The long-term goal of our research is to design and develop novel technologies to better support real-time, seamless data sharing between pre-hospital and hospital teams. To achieve this goal, we first need to answer several fundamental research questions (RQs):
RQ1: What types of information are commonly collected and shared by pre-hospital providers in the field?
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RQ2: What types of pre-hospital information are needed by hospital teams for ensuring appropriate preparation?
RQ3: What challenges and barriers exist in the pre-hospital communication process?
In this paper, we describe a mixed-methods ethnographic research conducted with both pre-hospital and hospital providers to answer these research questions and inform technological interventions for facilitating the acquisition and dissemination of pre-hospital information in the field.
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