Human Factors Considerations in the Design and Implementation of Telemedicine-Integrated Ambulance-Based Environments for Stroke Care (South Carolina)

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Project Details - Ended


Treating an evolving stroke with Plasminogen Activator (tPA) within 3 hours of symptom onset markedly reduces adverse sequelae of strokes, such as physical and mental disabilities. The absolute time between onset of symptoms and definitive treatment is, therefore, critical. However, greater than 95 percent of hospitals in the US have a tPA treatment rate of 10 percent, with the majority of diagnoses being made outside of the treatment window. Using ambulance-based telemedicine allows the time of transport to be used for patient evaluation and diagnosis. Such existing programs have led to a reduction of time to treatment by approximately 50 percent.

Emergency Medical Services in Georgetown County, South Carolina, with their partners the Medical University of South Carolina (MUSC) Center for Telehealth, have successfully implemented a pilot stroke telemedicine system in two ambulances. The system allows 24-hour access to MUSC’s stroke care experts, giving an ability to provide a stroke neurology consult in as little as 9 minutes. Prior to expansion beyond the pilot, the researchers have identified a critical need to evaluate the use of the system in these stressful, physically constrained environments. Such environments place high cognitive, physical, and temporal demands on caregivers and may lead to potential errors.

The specific aims of the research were as follows:

  • Evaluate the demands placed on the caregivers, the usability of the telemedicine system, and the barriers in the workflow associated in a telemedicine-integrated, ambulance-based setting for stroke care. 
  • Iteratively develop and refine guidelines and recommendations for large-scale implementation of telemedicine systems for stroke care in ambulances. 

Mixed methods, including observational studies and semi-structured interviews, will be used to evaluate workflow, space constraints, communication patterns, software usability, and teamwork of the current pilot implementation. The evaluation will look to human factors-related issues experienced by providers and from this create recommendations for a human-centered system design of ambulance-based telemedicine stroke programs. The results of this evaluation will be used to refine the system design, improve guidelines around process flow, and modify the software to enhance the system so that it can be implemented on a large scale. The ultimate goal is to increase the frequency of tPA definitive therapy of acute stroke to reduce and avoid adverse sequelae of strokes.