Continuous individual feedback to nurses at emergency medical dispatch centres: a stepped-wedge, interrupted time series analysis.

Background: Clinical feedback is often lacking in prehospital care, and while performance data is increasingly available to clinical and operational leadership, it is seldom made available to care providers themselves. In this study, we investigate the impact of a simple intervention consisting of the provision of monthly feedback reports via email to emergency medical dispatch nurses in three Swedish regions.

Method: Individualised reports consisting of 14 measures divided into descriptive (eg, priority-setting and call times), process (eg, dispatch times and documentation completeness) and outcome (eg, over/under triage rate) categories were developed with staff and management input. Report delivery was implemented using a stepped-wedge design, and effects were evaluated using a hierarchical regression-based interrupted time series analysis.

Results: 40 dispatchers were included in the study between March 2020 and October 2023, who handled a total of 246 353 incidents. Some impacts on documentation-related process measures were identified, with the odds of complete documentation increasing by 7.5% (95% CI 5.1 to 9.9) and the odds of having a documented contact reason increasing by 3.8% (1.5-5.9). These effects remained robust over the post-intervention period. Weaker impacts on outcome measures were identified which could be explained by a higher priority given to emergency medical dispatches overall.

Conclusion: Providing performance data can influence care providers to adjust their behaviour to improve process-related quality metrics under their direct control. The intervention may also have induced nurses to more often upgrade the priority of their patients. Improving outcome metrics may however require more intensive, multifaceted interventions.