Health Services Research & Development

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Williams LS, Patel H, Martin H, Rattray NA, Miech EJ, Savoy A, Graham G, Martini J, Anderson JA, Damush TM. Effective Communication and Engagement Cultivates Teamwork Among Virtual Telestroke Providers. [Abstract]. Stroke. 2019 Feb 1; 50(Suppl 1):ATP384.
Abstract: Background: In most hub-and-spoke telestroke systems, geographically co-located hub stroke specialists support regional spoke sites. In the VA's National Telestroke Program (NTSP), a virtual hub of stroke specialists located around the country provides 24/7 consults nationwide. We examined how stroke specialists adapted to virtual teamwork, and identified factors important in developing and sustaining a high-functioning virtual team. Methods: Semi-structured, confidential interviews with hub stroke specialists were audiotaped and transcribed. Probes were used to explore the extent to which providers had developed a sense of a teamness or a community of practice, and what factors helped or hindered this development. Core elements of a high-functioning team were defined using Mitchell's taxonomy, developed as part of the IOM's Best Practices Innovation Collaborative. Each interview transcript was independently coded by two investigators using NVivo11. The constant comparative method and matrix displays were used to identify themes, with special attention to themes about team, communication, trust, and satisfaction. Results: Of 13 hub providers with > 8 months NTSP participation, 12 were interviewed; 7 had prior telestroke experience. Participants reported high levels of trust and sense of teamwork with their virtual colleagues, sometimes even more than with local colleagues. Factors facilitating perceived teamness included communicating via a weekly case conference call, a sense of transparency in discussing challenges, engagement in NTSP development tasks, and leadership support. Lack of in-person contact decreased perceived teamness, but having an in-person NTSP meeting helped mitigate this issue. Despite technical challenges, providers reported high levels of satisfaction with the NTSP. Conclusions: Practicing as a virtual Telestroke hub provider can provide an equal or greater sense of trust and sense of teamwork with colleagues compared with traditional practice. Engaging in transparent discussion of challenging cases and contributing to program improvements may be key to promoting high-functioning virtual teams. Ongoing surveys will assess providers' satisfaction with program outcomes over time.