TACTICS VR Stroke Telehealth Virtual Reality Training for Health Care Professionals Involved in Stroke Management at Telestroke Spoke Hospitals: Module Design and Implementation Study

Abstract

Background Stroke management in rural areas is more variable and there is less access to reperfusion therapies, when compared with metropolitan areas. Delays in treatment contribute to worse patient outcomes. To improve stroke management in rural areas, health districts are implementing telestroke networks. The New South Wales Telestroke Service provides neurologist-led telehealth to 23 rural spoke hospitals aiming to improve treatment delivery and patient outcomes. The training of clinical staff was identified as a critical aspect for the successful implementation of this service. Virtual reality (VR) training has not previously been used in this context. Objective We sought to develop an evidence-based VR training module specifically tailored for stroke telehealth. During implementation, we aimed to assess the feasibility of workplace deployment and collected feedback from spoke hospital staff involved in stroke management on training acceptability and usability as well as perceived training impact. Methods The TACTICS VR Stroke Telehealth application was developed with subject matter experts. During implementation, both quantitative and qualitative data were documented, including VR use and survey feedback. VR hardware was deployed to 23 rural hospitals, and use data were captured via automated Wi-Fi transfer. At 7 hospitals in a single local health district, staff using TACTICS VR were invited to complete surveys before and after training. Results TACTICS VR Stroke Telehealth was deployed to rural New South Wales hospitals starting on April 14, 2021. Through August 20, 2023, a total of 177 VR sessions were completed. Survey respondents (n=20) indicated a high level of acceptability, usability, and perceived training impact (eg, accuracy and knowledge transfer; mean scores 3.8-4.4; 5=strongly agree). Furthermore, respondents agreed that TACTICS VR increased confidence (13/18, 72%), improved understanding (16/18, 89%), and improved awareness (17/18, 94%) regarding stroke telehealth. A comparison of matched pre- and posttraining responses revealed that training improved the understanding of telehealth workflow practices (after training: mean 4.2, SD 0.6; before training: mean 3.2, SD 0.9; P<.001), knowledge on accessing stroke telehealth (mean 4.1, SD 0.6 vs mean 3.1, SD 1.0; P=.001), the awareness of stroke telehealth (mean 4.1, SD 0.6 vs mean 3.4, SD 0.9; P=.03), ability to optimally communicate with colleagues (mean 4.2, SD 0.6 vs mean 3.7, SD 0.9; P=.02), and ability to make improvements (mean 4.0, SD 0.6 vs mean 3.5, SD 0.9; P=.03). Remote training and deployment were feasible, and limited issues were identified, although uptake varied widely (0-66 sessions/site). Conclusions TACTICS VR Stroke Telehealth is a new VR application specifically tailored for stroke telehealth workflow training at spoke hospitals. Training was considered acceptable, usable, and useful and had positive perceived training impacts in a real-world clinical implementation context. Additional work is required to optimize training uptake and integrate training into existing education pathways.

Rollout of a statewide Australian telestroke network including virtual reality training is associated with improved hyperacute stroke workflow metrics and thrombolysis rate

“…Further, numerous confounding factors between hospitals (e.g., size, staffing, and resources) prevented a meaningful analysis comparing individual site data (e.g., correlating VR usage by site outcomes). We noted that VR usage was variable across sites and overall uptake was lower than expected with the majority of usage occurring in the first 4-months after deployment, consistent with our previous studies (Hood et al, 2021;Ryan et al, 2022;Maltby et al, 2023). As reported in our previous studies (Hood et al, 2021;Ryan et al, 2022;Maltby et al, 2023), we speculate that limited uptake may relate to local staffing, time availability for training, familiarity and attitudes to new technology and communications.…”

“…We noted that VR usage was variable across sites and overall uptake was lower than expected with the majority of usage occurring in the first 4-months after deployment, consistent with our previous studies (Hood et al, 2021;Ryan et al, 2022;Maltby et al, 2023). As reported in our previous studies (Hood et al, 2021;Ryan et al, 2022;Maltby et al, 2023), we speculate that limited uptake may relate to local staffing, time availability for training, familiarity and attitudes to new technology and communications. Funding to support onsite stroke coordinators and communications (e.g., initial site visit, community of practice, and case review) likely contributed to broader staff up-skilling and improved processes, although this could not be objectively quantified.…”

“…The TACTICS VR workflow training platform includes the initial TACTICS VR-Hyper-Acute Stroke Management and TACTICS VR-Stroke Telehealth modules. Each training module has been previously described in detail (Hood et al, 2021;Ryan et al, 2022;Maltby et al, 2023), including an overview of module design, content inclusions and data capture processes. The respective modules focus on training effective and timeefficient workflow processes for hyper-acute stroke, with each module starting from initial patient notification and progressing through assessment, imaging, decision, treatment and transport (Hood et al, 2021;Ryan et al, 2022;Maltby et al, 2023).…”

“…Each training module has been previously described in detail (Hood et al, 2021;Ryan et al, 2022;Maltby et al, 2023), including an overview of module design, content inclusions and data capture processes. The respective modules focus on training effective and timeefficient workflow processes for hyper-acute stroke, with each module starting from initial patient notification and progressing through assessment, imaging, decision, treatment and transport (Hood et al, 2021;Ryan et al, 2022;Maltby et al, 2023). The intent in the current study was for staff to use the TACTICS VR-Stroke Telehealth module as it specifically focuses on telestroke workflow processes.…”

“…We initially developed TACTICS VR as part of a package intervention to improve stroke treatment and workflow processes in regional hospitals across three Australian states (Hood et al, 2021;Ryan et al, 2022). The TACTICS VR Stroke Telehealth module was subsequently developed to support rollout of the NSW Telestroke Service by providing a step-bystep walkthrough of workflow processes and awareness of critical elements and infrastructure (Maltby et al, 2023). Our previous work assessing TACTICS VR training yielded promising feedback in terms of acceptability, usability, usefulness, perceived training impact and feasibility.…”