Table 2.
Plan-Do-Study-Act/Clinical Simulation Process
| CYCLE | PLAN | DO | STUDY | ACT |
|---|---|---|---|---|
| Six-month time period for telemedicine equipment research, installation of equipment, preparation of scenarios, training of actors, training of volunteer EMS provider, and physicians. Multiple dry runs with stakeholders were conducted before and between simulations. | ||||
| 1 | Develop a mobile telestroke system considering the needs of all end-users based on discussions with stakeholders. | Clinical simulation with trained actors | Poor audio quality, difficulty seeing physician, unstable monitor, connectivity difficulties, difficulty maneuvering camera | Use of headsets for all end-users, set physician layout larger on monitor, provide additional training of physicians of best positions and lighting, training EMS on proper positioning of monitor for patient evaluation, improve stability of mounting device, add presets to help physician maneuver PTZ, use of dual modem to improve connectivity |
| 2 | During multiple dry runs and discussion with stakeholders, we agreed on the above-stated action plan of cycle 1 and implemented the changes. | Clinical simulation with trained actors | Poor audio quality but improved, unable to use Sennheiser DECT system with wireless headsets due to uncharged batteries, unable to use presets and technical difficulty with software secondary to glitch in software update before simulation, connectivity difficulties on interstate (I-95) | Headsets for physicians only, repositioning of ambulance speaker/mike directly above patient's head, regularly scheduled simultaneous software updates, ensure presets can be used before additional testing, dual modem to improve connectivity on a private network, further development of software to improve consistency of use, and need for additional training |
| 3 | During multiple dry runs and discussion with stakeholders, we agreed on the above-stated action plan of cycle 1 and implemented the changes. |
Clinical simulation with trained actors | Poor audio quality reported by physicians, intermittent short pauses in video, and users recommended further training be provided before live implementation | Reinstall Sennheiser DECT system with wireless headsets with a protocol in place to ensure proper charging, developing online training modules for both EMS providers and physicians. |
DECT, Digital Enhanced Cordless Telecommunication; EMS, Emergency Medical Services; PTZ, pan-tilt-zoom.