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Development and Evaluation of a User-Centered Mobile Telestroke Platform.

Sherita N Chapman Smith1,2, Pamela C Brown3, Kaitlynne H Waits1

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Ambulance-based telestroke systems improve stroke diagnosis and treatment timeliness. User feedback highlighted areas for improvement in audibility and equipment stability before widespread implementation.

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Area of Science:

  • Neurology
  • Telemedicine
  • Emergency Medical Services

Background:

  • Reperfusion therapy is critical for acute ischemic stroke treatment within a narrow time window.
  • Ambulance-based telestroke offers a novel approach to enhance stroke diagnosis and treatment speed.
  • This study evaluates the usability and user experience of a mobile telestroke platform.

Purpose of the Study:

  • Assess the usability of an ambulance-based telestroke platform.
  • Identify user-perceived strengths and limitations of the mobile telemedicine system.
  • Evaluate the system's potential for improving prehospital stroke care.

Main Methods:

  • An ambulance was equipped with a mobile telemedicine system for remote stroke assessments.
  • Physicians evaluated scripted scenarios using the National Institutes of Health Stroke Scale (NIHSS) during transport.
  • Surveys including System Usability Scale (SUS) and NASA Task Load Index (NASA TLX), along with interviews, assessed user perceptions and experience.

Main Results:

  • 91% of mobile scenarios were successfully completed with a median time of 9 minutes.
  • Moderate inter-rater agreement was found for NIHSS scores between mobile and original assessments (weighted kappa = 0.46).
  • The mean SUS score was 68.8, with user feedback indicating issues with audibility, equipment stability, and safety.

Conclusions:

  • The ambulance-based telestroke system shows potential for improving prehospital stroke care.
  • Usability issues related to audibility, equipment stability, and safety require optimization.
  • Clinical simulation and Plan-Do-Study-Act methodology are recommended for improving telemedicine system quality before program implementation.