JMIR Publications

ABSTRACT

Background:

Workflow-related delays in acute stroke treatment contribute to worse patient outcomes. While delays occur in both metropolitan and rural areas, stroke management in rural areas is more variable and patients have less access to reperfusion therapies. To improve rural acute stroke management, many health districts are implementing telestroke networks. The New South Wales (NSW) Telestroke Service provides neurologist-led telehealth support to 23 rural hospitals aiming to improve treatment delivery and improve patient outcomes. Training of clinical staff was identified as a critical aspect for successful implementation of this service. Virtual reality (VR) training is increasingly used for on-site training, but has not previously been applied in this context.

Objective:

We sought to develop an evidenced-based VR training module specifically tailored for stroke telehealth. During implementation, we aimed to assess feasibility of workplace- deployment and collected trainee feedback on experience, perceived usability, acceptability and utility.

Methods:

TACTICS VR – Stroke Telehealth was developed with key context-experts for a standalone VR headset. During implementation, both quantitative and qualitative data were documented including VR usage and user feedback. VR hardware was deployed to 23 rural hospitals and training provided for local site coordinators. VR usage data was captured via automated WiFi transfer. Staff completing TACTICS VR training at 7 hospitals in a single local health district with corresponding ethics approval were invited to complete surveys before and after training. Additional feedback was documented from site coordinators and stakeholders.

Results:

TACTICS VR – Stroke Telehealth was deployed to 23 rural NSW hospitals starting in April 2021. Through August 20, 2023, 177 TACTICS VR sessions were completed by healthcare professionals. TACTICS VR users indicated a high level of usability, acceptability and utility in survey questions (e.g. training accuracy, knowledge transfer; mean scores 3.8 to 4.4; 5 = strongly agree; n=21). Further, they agreed that TACTICS VR increased confidence (72%), improved understanding (89%) and improved awareness (94%) of stroke telehealth. Comparing matched pre- versus post-training responses, training improved understanding of telehealth workflow practices (post-training = 4.2 +/- 0.6; pre-training = 3.2 +/- 0.9; P<.001), knowledge on accessing stroke telehealth (4.1 +/- 0.6 versus 3.1 +/- 1.0; P=.001), awareness of local stroke telehealth services / processes (4.1 +/- 0.6 versus 3.4 +/- 0.9; P=.03), ability to optimally communicate with colleagues (4.2 +/- 0.6 versus 3.7 +/- 0.9; P=.02) and ability to make improvements in stroke care (4.0 +/- 0.6 versus 3.5 +/- 0.9; P=.03; Fig 6C). Remote training and deployment were feasible and limited issues were identified, although training uptake varied widely across sites (0 to 66 sessions per site).

Conclusions:

TACTICS VR – Stroke Telehealth is a fit-for-purpose training application that is usable, acceptable, useful and feasible for delivery of on-site training at rural hospitals.