Center for Health Facilities, Design and Testing, Clemson University, SC, USA.
Department of Civil & Industrial Engineering, Clemson University, SC, USA.
HERD. 2022 Apr;15(2):96-115. doi: 10.1177/19375867211054759. Epub 2021 Nov 11.
The purpose of this study is to understand the nature and source of disruptions in an ambulance during the telemedicine-based caregiving process for stroke patients to enhance the ambulance design for supporting telemedicine-based care.
Telemedicine is emerging as an efficient approach to provide timely remote assessment of patients experiencing acute stroke in an ambulance. These consults are facilitated by connecting the patient and paramedic with a remotely located neurologist and nurse using cameras, audio systems, and computers. However, ambulances are typically retrofitted to support telemedicine-enabled care, and the placement of these systems inside the ambulance might lead to spatial challenges and disruptions during patient evaluation.
Video recordings of 13 simulated telemedicine-based stroke consults were coded and analyzed using an existing systems-based flow disruption (FD) taxonomy. For each observed disruption-the type, severity or impact, location in the ambulance, and equipment involved in the disruption were recorded.
Seat size, arrangement of assessment equipment, location of telemedicine equipment (computer workstation), and design of telemedicine camera were among the factors that impacted telemedicine-related disruptions. The left ambulance seat zone and head of the patient bed were more involved in environmental hazard-related disruptions, while the right zone of the ambulance was more prone to interruptions and communication-related disruptions.
Adequate evaluation space for the paramedic, proper placement of evaluation equipment, and telemedicine computer location could facilitate the stroke care evaluation process and reduce FDs in the ambulance.
本研究旨在了解在基于远程医疗的脑卒中患者护理过程中救护车内部的干扰源和干扰性质，以改进支持基于远程医疗的护理的救护车设计。
远程医疗是为在救护车内的急性脑卒中患者提供及时远程评估的一种有效方法。这些会诊通过摄像机、音频系统和计算机将患者和护理人员与远程的神经科医生和护士连接起来。然而，救护车通常是经过改装来支持远程医疗的，这些系统在救护车内部的安装位置可能会导致空间挑战，并在患者评估过程中产生干扰。
对 13 次模拟远程医疗为基础的脑卒中会诊的视频记录进行了编码，并使用现有的基于系统的流程中断（FD）分类法进行了分析。记录了每个观察到的中断类型、严重程度或影响、救护车中的位置以及中断所涉及的设备。
座椅尺寸、评估设备的布置、远程医疗设备（计算机工作站）的位置以及远程医疗摄像机的设计是与远程医疗相关的干扰因素。救护车左侧座位区域和患者床的头部更容易受到环境危害相关的干扰，而救护车的右侧区域更容易受到干扰和通信相关的干扰。
为护理人员提供足够的评估空间，合理放置评估设备和远程医疗计算机的位置，可以促进脑卒中护理评估过程，并减少救护车内的 FD。
