Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jul 2, 2026
Date Accepted: Sep 25, 2026
Implementation and Evaluation of the Stroke Triage App among Paramedics in Prehospital Emergency Care: A Sequential Mixed-Method Study
ABSTRACT
Background:
Digital decision-support tools, such as the Stroke Triage App (STA), may enhance prehospital triage and clinical decision-making for suspected stroke patients. However, implementation of decision-support tools and their impact on clinical practice remains insufficiently studied.
Objective:
We aimed to investigate paramedics’ experiences with the implementation of the STA in prehospital practice by evaluating the implementation process, the resulting implementation outcomes, and its impact on clinical workflows.
Methods:
STA implementation was evaluated among paramedics in two 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 semi-structured interviews.
Results:
Monthly triages ranged from 52 to 153 (median 120, IQR 107–131). Paramedics’ individual STA use ranged from one to 47 times (median 7, IQR 3–13). Out of 246 paramedics with an account, 76 (31%) completed the survey, nine (4%) participated in semi-structured 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 highlights that, despite barriers in usability and perceived added value, the STA is largely successfully implemented in two ambulance regions in the Netherlands. Initial adoption and sustained use are shaped by usability, workflow integration, and perceived usefulness. These findings underline the importance of addressing contextual and organizational factors when implementing digital decision-support tools in emergency care.
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