I was an elementary school student when I first heard the word, “stroke.” My grandmother—a breast cancer survivor and mother of 11—suffered a stroke, but I was too young to understand its effects. I recognized that my grandmother was different and could no longer live alone, but the word stroke was too intangible to grasp. Decades later, this word resurfaced and redefined my elementary school memories. Another family member…another stroke.
This past September, my uncle suffered a stroke. Through my education and work experiences, I could now understand its medical causes and consequences. But without firsthand experience, I still couldn't comprehend its life-changing effects. The Health for America (HFA) at MedStar Health fellowship gave me the opportunity to better understand a stroke patient’s experience by incorporating a multiphase telestroke simulation in the exploration phase of the curriculum.
Overview of my telestroke simulation
Phase one of my telestroke simulation took place in MedStar Southern Maryland Hospital Center’s Emergency Department (ED). Similar to a patient who presents to the ED with stroke-like symptoms, I simulated going through the processes of triage, physician evaluation, imaging, telestroke consultation, and tissue plasminogen activator (tPA) medication decision-making. Phase one of the simulation was led by Dr. Ethan Booker, Dr. Kevin Reed, and Dr. Amie Hsia, among other contributing colleagues.
MedStar St. Mary’s Hospital, MedStar Southern Maryland Hospital Center, and MedStar Montgomery Medical Center currently use telestroke in their EDs to connect patients to MedStar's expert stroke neurologists via video teleconsultations.
Phase two of the simulation took the format of a 72-hour, post-discharge, work/home simulation. During this phase, I simulated the real-life challenges of both managing medications and performing daily activities with a complete loss of my left visual field and weakness on the left side of my body.
Human-centered telestroke design
Human-centered design can broadly be defined as designing solutions with empathy. As IDEO describes it, human-centered design is “a process that starts with the people you're designing for and ends with new solutions that are tailor made to suit their needs”.
While lying in the hospital bed during phase one of the telestroke simulation, I found myself looking for a way to slow down time and process the whirlwind of tests, evaluations, images, and consultations. As a stroke simulation patient, human-centered design principles were the last thing on my mind. Nevertheless, my experience at MedStar Southern Maryland Hospital Center was designed using principles of provider- and patient-centered design. From the angle of the telestroke video camera to the placement of the external telestroke microphone, this process was designed for me (the patient). Likewise, the usability and functionality of the telestroke software was designed with the provider in mind. For example, when the off-site expert stroke neurologist video calls the ED telestroke workstation computer, the computer automatically answers the video call request from the neurologist. This automated answering function removes unneeded clicks from the ED provider’s workflow.
The MedStar Telehealth Innovation Center, MedStar Southern Maryland Hospital Center, and MedStar Washington Hospital Center teams also treated my simulation as a chance to review and enhance workflow and patient experience more broadly—demonstrating how MedStar Health leverages simulation and human-centered design to improve as a system.
Reflections on my telestroke simulation experience
Everything about this telestroke simulation was personal. As I was lying in the hospital bed during phase one of the simulation, I could better imagine the fear, anxiety, and uncertainty my grandmother and uncle must have felt as they were brought into the EDs of their local community hospitals. As I completed the 72-hour post-discharge phase of the simulation, I couldn’t help but feel the frustration, confusion, and fear my grandmother and uncle undoubtedly felt when they were discharged with physical and cognitive impairments.
As I write this blog, I am also reminded that my family history of stroke means I may be at a higher risk of having this disease in the future. While neither of my parents have had a stroke, the genetic risk factors that contributed to my grandmother and uncle’s strokes are prevalent on my father’s side of the family: high blood pressure, high cholesterol, and diabetes.
I anticipated the HFA telestroke simulation would help me connect principles of human-centered design to telehealth, yet I didn’t fully expect the insights into living with an impairment that profoundly changes life. The experience also reminded me that behind every patient experiencing an acute health event, there’s a network of loved ones also impacted.