Impact of a Decision-Support Interface on Mental Workload and Stress in Prehospital Stroke Triage: A Randomized Crossover Trial.
- 1National Tsing Hua University, Department of Industrial Engineering and Engineering Management, Hsinchu, Taiwan.
- 2National Taiwan University Hospital, Stroke Center and Department of Neurology, Taipei, Taiwan.
- 3National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan.
Abstract
Introduction
Prehospital triage challenges often lead to suboptimal choices and delayed treatment for stroke patients. The objective of the study was to evaluate whether a decision-support interface to assist in stroke triage to an appropriate hospital could reduce emergency medical technicians' (EMT) mental workload.Methods
This randomized crossover study was conducted between February and March 2025. Each participant completed two 12-minute simulated trials in randomized order: current dispatch orders without decision support and a decision-support interface. We assessed mental workload-the mental effort required to make hospital transport decisions under time pressure during prehospital stroke triage-using heart rate variability (HRV) metrics and the National Aeronautics and Space Administration Task Load Index (NASA-TLX). System usability was assessed using the System Usability Scale. The primary outcome was the root mean square of successive differences for each participant after completing the two trials. The secondary outcomes included the differences of NASA-TLX, System Usability Scale, and other heart rate variability parameters, including mean R-R interval (meanRR), mean heart rate, percentage of successive R-R intervals that differ by more than 50 milliseconds, low-frequency power (LF), high-frequency (HF) power, and the LF/HF ratio. Subgroup analyses examined differences by sex, education, age, and years of service.Results
A total of 35 emergency medical technician (EMT)-intermediate participants (mean age, 27.5 [5.3] years) completed the study. For the primary outcome, the root mean square of successive differences increased significantly (28.1 [13.0] vs 32.4 [13.6] milliseconds; mean difference, 4.3 milliseconds [95% CI, 1.57-6.99]; P < .01), indicating reduced mental workload when the participants used the decision-support interface. For the secondary outcomes, mean heart rate (77.5 [8.6] vs 73.8 [10.6], P < .01) decreased, mean R (784.2 [89.5] vs 808.9 [87.3], P < .01) increased, and HF power (370.1 [291.7] versus 482.6 [433.9], P = .02) increased, suggesting reduced mental workload when the participants used the decision-support interface. The mental demand scores in NASA-TLX decreased from 62.5 (14.6) to 35.5 (17.0). Emergency medical technicians with 1.0-1.5 years of service reported higher System Usability Scale scores than those with 1.5-3.0 years (84.4 versus 71.3, P = .02), and 82.9% of participants rated the system as acceptable (System Usability Scale score ≥ 70).Conclusion
This study demonstrated that integrating a web-based decision-support interface effectively reduces mental workload and psychological stress among EMTs in stroke triage.
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BibTeX
@article{lu2026impact,
title = {{Impact of a Decision-Support Interface on Mental Workload and Stress in Prehospital Stroke Triage: A Randomized Crossover Trial.}},
author = {Yu-Chi Lu and Sung-Chun Tang and Li-Kai Tsai and Jiann-Shing Jeng and Yu-Ching Lee and Ming-Ju Hsieh},
journal = {The western journal of emergency medicine},
year = {2026},
month = sep,
doi = {10.5811/westjem.61934},
url = {https://europepmc.org/article/MED/42900912},
note = {CC BY},
}
RIS
TY - JOUR
TI - Impact of a Decision-Support Interface on Mental Workload and Stress in Prehospital Stroke Triage: A Randomized Crossover Trial.
AU - Yu-Chi Lu
AU - Sung-Chun Tang
AU - Li-Kai Tsai
AU - Jiann-Shing Jeng
AU - Yu-Ching Lee
AU - Ming-Ju Hsieh
PY - 2026
DA - 2026/09/05
JO - The western journal of emergency medicine
DO - 10.5811/westjem.61934
UR - https://europepmc.org/article/MED/42900912
AB - Introduction Prehospital triage challenges often lead to suboptimal choices and delayed treatment for stroke patients. The objective of the study was to evaluate whether a decision-support interface to assist in stroke triage to an appropriate hospital could reduce emergency medical technicians' (EMT) mental workload.Methods This randomized crossover study was conducted between February and March 2025. Each participant completed two 12-minute simulated trials in randomized order: current dispatch orders without decision support and a decision-support interface. We assessed mental workload-the mental effort required to make hospital transport decisions under time pressure during prehospital stroke triage-using heart rate variability (HRV) metrics and the National Aeronautics and Space Administration Task Load Index (NASA-TLX). System usability was assessed using the System Usability Scale. The primary outcome was the root mean square of successive differences for each participant after completing the two trials. The secondary outcomes included the differences of NASA-TLX, System Usability Scale, and other heart rate variability parameters, including mean R-R interval (meanRR), mean heart rate, percentage of successive R-R intervals that differ by more than 50 milliseconds, low-frequency power (LF), high-frequency (HF) power, and the LF/HF ratio. Subgroup analyses examined differences by sex, education, age, and years of service.Results A total of 35 emergency medical technician (EMT)-intermediate participants (mean age, 27.5 [5.3] years) completed the study. For the primary outcome, the root mean square of successive differences increased significantly (28.1 [13.0] vs 32.4 [13.6] milliseconds; mean difference, 4.3 milliseconds [95% CI, 1.57-6.99]; P < .01), indicating reduced mental workload when the participants used the decision-support interface. For the secondary outcomes, mean heart rate (77.5 [8.6] vs 73.8 [10.6], P < .01) decreased, mean R (784.2 [89.5] vs 808.9 [87.3], P < .01) increased, and HF power (370.1 [291.7] versus 482.6 [433.9], P = .02) increased, suggesting reduced mental workload when the participants used the decision-support interface. The mental demand scores in NASA-TLX decreased from 62.5 (14.6) to 35.5 (17.0). Emergency medical technicians with 1.0-1.5 years of service reported higher System Usability Scale scores than those with 1.5-3.0 years (84.4 versus 71.3, P = .02), and 82.9% of participants rated the system as acceptable (System Usability Scale score ≥ 70).Conclusion This study demonstrated that integrating a web-based decision-support interface effectively reduces mental workload and psychological stress among EMTs in stroke triage.
SN - 1936-900X
SN - 1936-9018
ER -