Abstract Background and aims 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 in clinical practice remains insufficiently studied. We aim to investigate the implementation, actual usage and usability of the STA to generate actionable insights for improvement of the STA and similar tools. 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 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, whereas clinical urgency, workflow integration, and less perceived added value influenced STA use. Users recommended improvements in mobile interface, login features and additional explanation with triage advice. Conclusions This study highlights that technical validation alone is insufficient for successful implementation of digital decision-support tools. 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. Conflict of interest All authors have nothing to disclose
Kremers et al. (Fri,) studied this question.