Industrial Engineering

Task, Usability, and Error Analyses of Ambulance-based Telemedicine for Stroke Care

Although there are multiple variations of strokes, ischemic strokes make up 87% of stroke occurrences. Following a CT scan to confirm the absence of brain bleeding, Thrombolytic therapy using tissue plasminogen activator (t-PA) is known to be one of the most successful treatments for stroke care. To be effective, however, tPA must be administered within 3 hours of stroke symptom onset. The utilization of telemedicine platforms en route to the hospital allows on-site paramedics to partner with both nurses who regulate documentation and procedural steps as well as neurologists who lead the processes of diagnosis. In this way, the instigation of treatment can occur either in ambulances or in a streamlined manner upon the patient’s arrival at the hospital.

The research team conducted observational sessions in which three caregivers—a nurse, a paramedic, and a neurologist—carried out the processes of virtual, collective, prehospital evaluations and diagnoses of acute stroke patients through the REACH telemedicine platform. The equipment involved within this platform includes a Dell laptop provided to neurologists, a mobile REACH cart with a camera and overhead speaker provided to nurses, and the addition of speakers, microphones, cameras, and monitors provided to paramedics in an ambulance-based setting.

The four research questions in the team’s “Task, Usability, and Error Analyses” focused on the following: the tasks involved in stroke assessment in a telemedicine integrated ambulance, the usability issues in the telemedicine interface, the potential errors that can be made using the telemedicine system, and how the predicted errors and heuristic violations be mitigated through enhanced system design. The team’s methodology employed observations of the stroke caregiving process, Hierarchical Task Analysis (HTA), Heuristic Evaluation, and System Human Error Reduction and Prediction Approach (SHERPA). Conducted between November 7, 2019, to January 26, 2020, the research was based in two major hospitals and a fire and EMS department in the southeast United States while connecting with the selected neurologists at MUSC. The team found issues with violations of common design heuristics through their evaluation method and issues with information communication and action errors through SHERPA.

This work has been published in the IISE Transactions on Healthcare Systems Engineering.