The purpose of this study is to understand the communication among care teams during telemedicine-enabled stroke consults in an ambulance.
Background
Telemedicine can have a significant impact on acute stroke care by enabling timely intervention in an ambulance before a patient reaches the hospital. However, limited research has been conducted on understanding and supporting team communication during the care delivery process for telemedicine-enabled stroke care in an ambulance.
Method
Video recordings of 13 simulated stroke telemedicine consults conducted in an ambulance were coded to document the tasks, communication events, and flow disruptions during the telemedicine-enabled stroke care delivery process.
Results
The majority (82%) of all team interactions in telemedicine-enabled stroke care involved verbal interactions among team members. The neurologist, patient, and paramedic were almost equally involved in team interactions during stroke care, though the neurologist initiated 48% of all verbal interactions. Disruptions were observed in 8% of interactions, and communication-related issues contributed to 44%, with interruptions and environmental hazards being other reasons for disruptions in interactions during telemedicine-enabled stroke care.
Conclusion
Successful telemedicine-enabled stroke care involves supporting both verbal and nonverbal communication among all team members using video and audio systems to provide effective coverage of the patient for the clinicians as well as vice versa.
Application
This study provides a deeper understanding of team interactions during telemedicine-enabled stroke care that is essential for designing effective systems to support teamwork.
AlsabriM.BoudiZ.LauqueD.RogerD. D.WhelanJ. S.ÖstlundhL.AllinierG.OnyejiC.MichelP.LiuS. W.Jr CamargoC. A.LindnerT.SlagmanA.BatesD. W.TazarourteK.SingerS. J.ToussiA.GrossmanS.BellouA. (2020). Impact of teamwork and communication training interventions on safety culture and patient safety in emergency departments. Journal of Patient Safety, Publish Ahead of Print.doi:10.1097/PTS.0000000000000782
Buljac-SamardzicM.Dekker-van DoornC. M.van WijngaardenJ. D. H.van WijkK. P. (2010). Interventions to improve team effectiveness: A systematic review. Health Policy, 94, 183–195.doi:10.1016/j.healthpol.2009.09.01519857910
4.
ButlerL.WhitfillT.WongA. H.GawelM.CrispinoL.AuerbachM. (2019). The impact of telemedicine on teamwork and workload in pediatric resuscitation: A simulation-based, randomized controlled study. Telemedicine and e-Health, 25, 205–212.doi:10.1089/tmj.2018.001729957150
5.
CookeN. J.GormanJ. C.MyersC. W.DuranJ. L. (2013). Interactive team cognition. Cognitive Science, 37, 255–285.doi:10.1111/cogs.1200923167661
6.
DemirM.McNeeseN. J.CookeN. J. (2017). Team situation awareness within the context of human-autonomy teaming. Cognitive Systems Research, 46, 3–12.doi:10.1016/j.cogsys.2016.11.003
7.
DietzA. S.PronovostP. J.Mendez-TellezP. A.WyskielR.MarstellerJ. A.ThompsonD. A.RosenM. A. (2014). A systematic review of teamwork in the intensive care unit: What do we know about teamwork, team tasks, and improvement strategies?Journal of Critical Care, 29, 908–914.doi:10.1016/j.jcrc.2014.05.02525001565
8.
GormanJ. C.CookeN. J.WinnerJ. L. (2006). Measuring team situation awareness in decentralized command and control environments. Ergonomics, 49, 1312–1325.doi:10.1080/0014013060061278817008258
9.
GormanJ. C.GrimmD. A.StevensR. H.GallowayT.Willemsen-DunlapA. M.HalpinD. J. (2020). Measuring real-time team cognition during team training. Human Factors, 62, 825–860.doi:10.1177/001872081985279131211924
10.
GormanJ. C.MartinM. J.DunbarT. A.StevensR. H.GallowayT. (2013). Analysis of semantic content and its relation to team neurophysiology during submarine crew training. InSchmorrowD.D..GallowayT. (Eds.), Foundations of augmented cognition. AC 2013. Lecture notes in computer science (Vol. 8027, pp.143–152). Springer.doi:https://doi.org/10.1007/978-3-642-39454-6_15
11.
GrimmD. A.GormanJ. C.StevensR. H.GallowayT. L.Willemsen-DunlapA. M.HalpinD. J. (2017). Demonstration of a method for real-time detection of anomalies in team communication. [Conference session]. Paper Presented at the Proceedings of the Human Factors and Ergonomics Society Annual Meeting, Los Angeles, CA.. September, 2017. 282–286.
12.
HealeyA. N.SevdalisN.VincentC. A. (2006). Measuring intra-operative interference from distraction and interruption observed in the operating theatre. Ergonomics, 49, 589–604.doi:10.1080/0014013060056889916717011
13.
HughesA. M.GregoryM. E.JosephD. L.SoneshS. C.MarlowS. L.LacerenzaC. N.BenishekL. E.KingH. B.SalasE. (2016). Saving lives: A meta-analysis of team training in healthcare. Journal of Applied Psychology, 101, 1266–1304.doi:10.1037/apl0000120
14.
KwahL. K.DiongJ. (2014). National institutes of health stroke scale (NIHSS). Journal of Physiotherapy, 60, 61.doi:10.1016/j.jphys.2013.12.01224856948
15.
LazzaraE. H.BenishekL. E.PatzerB.GregoryM. E.HughesA. M.HeyneK.SalasE.KuchkarianF.MarttosA.SchulmanC. (2015). Utilizing telemedicine in the trauma intensive care unit: Does it impact teamwork?Telemedicine and e-Health, 21, 670–676.doi:10.1089/tmj.2014.007425885369
16.
LimanT. G.WinterB.WaldschmidtC.ZerbeN.HufnaglP.AudebertH. J.EndresM. (2012). Telestroke ambulances in prehospital stroke management: Concept and pilot feasibility study. Stroke, 43, 2086–2090.doi:10.1161/STROKEAHA.112.65727022693132
17.
LinF.ChaboyerW.WallisM. (2009). A literature review of organisational, individual and teamwork factors contributing to the ICU discharge process. Australian Critical Care, 22, 29–43.doi:10.1016/j.aucc.2008.11.00119138531
18.
MarlowS. L.LacerenzaC. N.PaolettiJ.BurkeC. S.SalasE. (2018). Does team communication represent a one-size-fits-all approach? A meta-analysis of team communication and performance. Organizational Behavior and Human Decision Processes, 144, 145–170.doi:10.1016/j.obhdp.2017.08.001
19.
MarlowS. L.LacerenzaC. N.SalasE. (2017). Communication in virtual teams: A conceptual framework and research agenda. Human Resource Management Review, 27, 575–589.doi:10.1016/j.hrmr.2016.12.005
20.
McNeeseM. D. (2016). The phenomenal basis of human factors: Situating and distributing cognition within real-world activities. Journal of Cognitive Engineering and Decision Making, 10, 116–119.
21.
MillsP.NeilyJ.DunnE. (2008). Teamwork and communication in surgical teams: Implications for patient safety. Journal of the American College of Surgeons, 206, 107–112.doi:10.1016/j.jamcollsurg.2007.06.28118155575
22.
MohammedS.FerzandiL.HamiltonK. (2010). Metaphor no more: A 15-year review of the team mental model construct. Journal of Management, 36, 876–910.doi:10.1177/0149206309356804
23.
PalmerG.AbernathyJ. H.SwintonG.AllisonD.GreensteinJ.ShappellS.JuangK.ReevesS. T. (2013). Realizing improved patient care through human-centered operating room design. Anesthesiology, 119, 1066–1077.doi:10.1097/ALN.0b013e31829f68cf
24.
PappasY.SealeC. (2009). The opening phase of telemedicine consultations: An analysis of interaction. Social Science & Medicine, 68, 1229–1237.doi:10.1016/j.socscimed.2009.01.01119201514
25.
PavlopoulosS.KyriacouE.BerlerA.DembeyiotisS.KoutsourisD. (1998). A novel emergency telemedicine system based on wireless communication technology-ambulance. IEEE Transactions on Information Technology in Biomedicine, 2, 261–267.doi:10.1109/4233.73758110719536
26.
RogersH.Chalil MadathilK.JosephA.McNeeseN.HolmstedtC.HoldenR. J.McElligottJ. T. (2020). Task, usability, and error analyses of ambulance-based telemedicine for stroke care. IISE Transactions on Healthcare Systems Engineering.
27.
RogersH.MadathilK. C.AgnisarmanS.NarasimhaS.AshokA.NairA.WelchB. M.McElligottJ. T. (2017). A systematic review of the implementation challenges of telemedicine systems in ambulances. Telemedicine and e-Health, 23, 707–717.doi:10.1089/tmj.2016.024828294704
28.
RogersH.PonathilA.Chalil MadathilK.JosephA.McNeeseN.HolmstedtC.McElligottJ. (2020). Evaluation and prediction of human error in ambulance-based telemedicine stroke assessment. [Conference session]. Paper presented at the Human Factors and Ergonomics Society Annual Meeting, Virtual.
29.
SacksG. D.ShannonE. M.DawesA. J.RolloJ. C.NguyenD. K.RussellM. M.KoC. Y.Maggard-GibbonsM. A. (2015). Teamwork, communication and safety climate: A systematic review of interventions to improve surgical culture. BMJ Quality & Safety, 24, 458–467.doi:10.1136/bmjqs-2014-00376426002946
30.
SalasE.CookeN. J.RosenM. A. (2008). On teams, teamwork, and team performance: Discoveries and developments. Human Factors, 50, 540–547.doi:10.1518/001872008X28845718689065
31.
SalasE.ReyesD. L.McDanielS. H. (2018). The science of teamwork: Progress, reflections, and the road ahead. American Psychologist, 73, 593–600.doi:10.1037/amp000033429792470
32.
SalasE. E.FioreS. M. (2004). Team cognition: Understanding the factors that drive process and performance. American Psychological Association.
SaverJ. L.FonarowG. C.SmithE. E.ReevesM. J.Grau-SepulvedaM.PanW.OlsonD. M.HernandezA. F.PetersonE. D.SchwammL. H. (2013). Time to treatment with intravenous tissue plasminogen activator and outcome from acute ischemic stroke. JAMA, 309, 2480–2488.doi:10.1001/jama.2013.695923780461
35.
SchmutzJ. B.EppichW. J. (2019). When I say… team reflexivity. Medical Education, 53, 545–546.doi:10.1111/medu.1376830444006
36.
TiferesJ.HusseinA. A.BisantzA.HigginbothamD. J.SharifM.KozlowskiJ.AhmadB.O’HaraR.WawrzyniakN.GuruK. (2019). Are gestures worth a thousand words? Verbal and nonverbal communication during robot-assisted surgery. Applied Ergonomics, 78, 251–262.doi:10.1016/j.apergo.2018.02.01529525267
37.
WahrJ. APragerR. LAbernathyJ. HMartinezE. ASalasESeifertP. CGroomR. CSpiessB. DSearlesB. ESundtT. MSanchezJ. AShappellS. ACuligM. HLazzaraE. HFitzgeraldD. CThouraniV. HEghtesadyPIkonomidisJ. SEnglandM. R. . . American Heart Association Council on Cardiovascular Surgery and Anesthesia, Council on Cardiovascular and Stroke Nursing, and Council on Quality of Care and Outcomes Research. (2013). Patient safety in the cardiac operating room: Human factors and teamwork: A scientific statement from the American heart association. Circulation, 128, 1139–1169.doi:10.1161/CIR.0b013e3182a38efa23918255
38.
WeaverS. J.DyS. M.RosenM. A. (2014). Team-training in healthcare: A narrative synthesis of the literature. BMJ Quality & Safety, 23, 359–372.doi:10.1136/bmjqs-2013-00184824501181
39.
WhittenP. S.AllenA. (1995). Analysis of telemedicine from an organizational perspective. Telemedicine Journal, 1, 203–213.doi:10.1089/tmj.1.1995.1.20310165157
40.
YperzeeleL.Van HooffR.-J.De SmedtA.Valenzuela EspinozaA.Van DyckR.Van de CasseyeR.ConventsA.HubloueI.LauwaertD.De KeyserJ.BrounsR. (2014). Feasibility of AmbulanCe-Based Telemedicine (FACT) study: Safety, feasibility and reliability of third generation in-ambulance telemedicine. PLoS One, 9, e110043.doi:10.1371/journal.pone.011004325343246
