In this article we'll be showing you an example of how to create a patient scenario with state auto-progression.
Our patient "Alex Panic Disorder" sees a doctor with symptoms of a coming panic attack. During his visit / interview with the doctor he starts feeling worse, then, for the treatment of the doctor reacts well.
During the simulation we want him to go show the following symptoms, go through the following states:
- Initial Patient State: elevated heart and respiratory rates
- Start of Panic Attack: hear rate and respiratory rates slowly increasing
- Panic Attack getting worse: heart rate and respiratory rates high
- Panic Attack treatment: treatment provided to patient
- Panic Attack getting better: patient feeling better
Initial Patient state:
As our patient arrives with slightly elevated heart and respiratory rates we opened the Initial Patient State from under the States tab and made the necessary modifications under the Vitals tab.
Start of Panic Attack
In this state our patient's heart rate and respiratory rate should gradually increase, so we again made the necessary modifications to the Vitals settings
We not only modified the heart rate and respiratory rates, but have also set a 30 second onset for both ensuring that the vital rates gradually increase.
Next we defined a trigger point (criteria) for this state to automatically start during the running session.
Under the "Autostart" tab we added the criteria that the patient must say "I feel like I am going to have a panic attack" for this state to start.
However, for our patient to be able to meet this conversation related criteria, we also needed to make sure that he can provide us this response in the previous state.
This we needed to set up under the "Conversation" settings of the previous "Initial patient state".
Now, when we run the patient with the Initial Patient State and ask ALEX "What brings you in today" for example, he will answer "I feel like I'm going to have a panic attack." so the patient can switch to our second state and start elevating their heart rate and respiratory rate with our onset.
Panic Attack getting worse state
In this state our patient's panic attack has gotten worse, and we want them to let us know about this.
Under the Autostart tab we have created a criteria that this state should kick in when the patient's heart rate goes above 100 BPM. To create this type of criteria we chose the criteria type "Vital sign value:".
We also wanted to make sure that this criteria is taken into consideration since the beginning of our previous state, which was the "Start of Panic Attack" state. So we added this setting through the "happens since starting" drop down menu.
As in the previous, "Start of Panic Attack" state we have set the patient’s heart rate to gradually rise to 110 BPM with a 30 second onset, as soon as this value is reached our new patient state should automatically start.
But we wanted our patient to signal to us somehow that they've entered this new state. So under the Speech tab we've added the sentence "It's getting worse, it's getting worse." for the patient to say when they enter this state.
Panic Attack treatment
In this state we want to provide our patient a solution. So we'll be keeping their vitals on the same elevated rate, but we'll want them to take a tranquilizer to help them ease faster.
We again want to add a conversation related criteria for this state, so we chose the criteria type "Speech conversation responds with:".
For our patient to be able to respond with "Okay. Thank you." we again needed to make sure that the Conversation settings in the previous "Panic Attack getting worse" state are aligned, so that the patient can respond to our question as needed during that state.
Now, when we ask our patient the question "Could you please take this tranquilizer pill now?" during the "Panic Attack getting worse" state and the patient responds with "Okay. Thank you." the next "Panic Attack treatment " state will automatically start.
We again wanted to make sure we also get notified of the state switch from our patient, so we made sure our patient says "Should I continue to do some breathing exercises as well?" by entering this sentence under the Speech tab of the "Panic Attack treatment" state.
Panic Attack getting better
In this state we wanted our patient to let us know that they are slowly feeling better. So in this state we changed the Vitals settings for their heart rate and respiratory rate to gradually go back to normal values in 50 seconds once the state kicks in.
Then we created a criteria for launching this state. This time we chose to use a Log entry type criteria, where we set that if during the simulation we enter a log entry that includes "getting better" then the "Panic Attack getting better" state should automatically start.
Finally, we wanted our patient to let us know they are feeling better once they've entered this state. So, under the Speech tab we've set for them to say "I think I am feeling better now. <laugh> Thank you.". We've even included a laughter voice effect to make it more realistic.
How it all panned out
Below you can see the images of the logs of our run session with this patient and how our patient automatically switched from one state to the other as per our settings above.
Note: event logs show in time of order from newest at the bottom and last at the top, please view below log records accordingly.
Initial Patient State - Start of Panic Attack
Start of Panic Attack - Panic Attack getting worse
Panic Attack getting worse - Panic Attack treatment
Panic Attack treatment - Panic Attack getting better
Panic Attack getting better
Hope you found this example helpful for creating your own custom patients with state auto-progression. But if you have any questions or need assistance, just drop us a line at firstname.lastname@example.org or contact us through our online chat support.