P.061 Stroke Care and Neurological Emergency Response Simulation
                        (SCaNERS): Creation and Implementation into a Resident Curriculum

Background: Resident physicians often observe stroke alerts before managing them alone. However, this practice exposes patients to potential harm from trainees’ lack of experience. To address this, we created a acute stroke simulation course. Simulation training offers a low-risk environment for skill acquisition, complimenting the Royal College’s recent transition away from a time-based to competency-based learning curriculum. The purpose of this project was to develop and implement a stroke simulation training program into resident neurology rotations at the University of Saskatchewan. Methods: Six high-fidelity acute stroke simulation cases were developed with the aid of a Simulation Operation Specialist. We identified objectives corresponding to Royal College Entrustable Professional Activities for Adult Neurology encompassing several diagnostic and therapeutic goals of acute stroke care. To increase fidelity, a standardized patient was recruited and trained on how to respond to neurologic exams given a specific stroke syndrome. A standardized debrief was given after each session in a safe, non-judgemental environment. Results: Simulation sessions have been running monthly since March 25, 2021. Conclusions: The creation and implementation of high-fidelity simulation training into a resident curriculum is feasible. Ongoing data is being collected to explore residents’ experiences and knowledge improvement in stroke, and to asses local reductions in treatment delays.

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Simulation-based training improves patient safety climate in acute stroke care (STREAM)

Neurological Research and Practice ◽

10.1186/s42466-021-00132-1 ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

Ferdinand O. Bohmann ◽

Joachim Guenther ◽

Katharina Gruber ◽

Tanja Manser ◽

Helmuth Steinmetz ◽

...

Keyword(s):

Patient Safety ◽

Acute Stroke ◽

Safety Climate ◽

Simulation Training ◽

Stroke Care ◽

Acute Stroke Care ◽

Safety Attitudes ◽

Patient Safety Climate ◽

Simulation Based ◽

Improvement Programs

Abstract Background Treatment of acute stroke performed by a multiprofessional, interdisciplinary team is highly time dependent. Interface problems are preprogrammed and pitfalls relevant to patient safety are omnipresent. The Safety Attitudes Questionnaire (SAQ) is a validated and widely used instrument to measure patient safety. The objective of this study was to evaluate the influence of Simulation-based Training of the Rapid Evaluation and Management of Acute Stroke (STREAM) on patient safety measured by SAQ in the context of acute stroke care. Methods During the STREAM trial at seven university hospitals in Germany from October 2017 to October 2018, an anonymous survey was conducted before and after the STREAM intervention centering around interdisciplinary simulation training. The questionnaire, based on the SAQ, included 33 items (5-point Likert scale, 1 = disagree to 5 = agree) and was addressed at the whole multiprofessional stroke team. Statistical analyses were used to examine psychometric properties as well as descriptive findings. Results In total 167 questionnaires were completed representing an overall response rate of 55.2%, including especially physicians (65.2%) and nurses (26.3%). Safety climate was significantly improved (pre-interventional: 3.34 ± .63 vs. post-interventional: 3.56 ± .69, p = .028). The same applies for teamwork climate among stroke teams (pre-interventional: 3.76 ± .59 vs. post-interventional: 3.84 ± .57, p = .001). The perceived benefit was most relevant among nurses. Conclusions The STREAM intervention centering around interdisciplinary simulation training increases perceived patient safety climate assessed by the SAQ in acute stroke therapy. These results have the potential to be a basis for future quality improvement programs.

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Simulation training programs for acute stroke care: Objectives and standards of methodology

European Stroke Journal ◽

10.1177/2396987320971105 ◽

2020 ◽

Vol 5 (4) ◽

pp. 328-335

Author(s):

Barbara Casolla ◽

Maria Alonso de Leciñana ◽

Raquel Neves ◽

Waltraud Pfeilschifter ◽

Veronica Svobodova ◽

...

Keyword(s):

Acute Stroke ◽

Simulation Training ◽

Time Window ◽

Stroke Care ◽

Education And Training ◽

Acute Stroke Care ◽

Simulation Techniques ◽

Team Working ◽

Set Up ◽

And Training

The European Stroke Organisation (ESO) Simulation Committee was established in 2017 with the intent to promote simulation education and training in the stroke field. The application of simulation methodology in education and training improves healthcare professional performances in real clinical practice and patient outcomes. We evaluated the implementation of simulation training in stroke medicine, how it can significantly affect stroke pathways and quality of care. We herewith describe simulation techniques in the acute stroke setting. Simulation programs place the trainees in a safe environment, allowing both role-playings for decision making training and procedural simulation for technical skills improvement. This paper includes the position of the Committee on the key points, principles, and steps in order to set up and promote simulation programs in European stroke centers. Stroke is an emergency, and hyperacute phase management requires knowledge, expertise, optimal multidisciplinary team working, and timely actions in a very narrow time window. The ESO Simulation Committee promotes the implementation of simulation training in stroke care according to a specific and validated methodology.

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Abstract TP313: Virtual Stroke Patient Simulation Training for Residents and Medical Students Improves Knowledge, Skill Sets and Confidence in Acute Stroke Care

Stroke ◽

10.1161/str.47.suppl_1.tp313 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Shreyas Gangadhara ◽

David Craig ◽

William Scott Burgin ◽

Clifton L Gooch ◽

Andrea Bozeman ◽

...

Keyword(s):

Medical Students ◽

Acute Stroke ◽

Stroke Patient ◽

Simulation Training ◽

Patient Simulation ◽

Stroke Care ◽

Procedural Skill ◽

Acute Stroke Care ◽

Skill Sets ◽

Or Practice

Introduction: At most teaching hospitals, first- and second-year residents respond to a “Stroke Alert” where “Time is Brain.” Interpreting neurologic signs and symptoms and acute management of stroke is complex. In many medical specialties, simulated instruction improves performance and addresses patient safety needs without harm to, or practice upon, a real-live patient. Thus, we designed a virtual stroke patient simulation training course: to boost knowledge, skill sets, and confidence in managing hyperacute stroke scenarios with this new first-responder audience in mind. Hypothesis: We hypothesize that performance outcomes, as measured by Declarative and Procedural (Skill Sets) Knowledge and Confidence will improve over the 1.5-day period of a virtual stroke patient simulated training course. Methodology: Incoming Neurology residents and medical students with minimal exposure to stroke care underwent the aforementioned stroke simulation course at the Center for Advance Medical Learning and Simulation (CAMLS) in Tampa, Florida, USA. It included 3 lectures on acute stroke care by USF faculty and 10 simulated scenarios of “Stroke Alerts” using standardized actors and electronic patient simulators. After each scenario, debriefing reviewed participants’ performance in Declarative and Procedural (Skill Set) Knowledge and Confidence. Results were analyzed using Likert scale on data collected prior to, and after, the course. Results: A repeated measures ANOVA demonstrated that, compared to pre-testing, post-testing data for Declarative and Procedural (Skill Set) Knowledge (F=14.05, p=.002) and Confidence (F=33.37, p<.001) of Acute Stroke management improved significantly for both residents and medical students alike. Conclusion: In conclusion, simulation training for acute stroke management is statistically and significantly effective for neurology residents and medical students. Simulation training addresses patient safety needs without harm to, or practice upon, real-live patients. Neurology residency programs across the country should consider designing similar programs or utilizing ours at CAMLS for optimal stroke care among beginning residents at the front line of stroke patient care.

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Berlin PRehospital Or Usual Delivery of Acute Stroke Care 2.0 (B_PROUD 2.0)

Case Medical Research ◽

10.31525/ct1-nct03931616 ◽

2019 ◽

Author(s):

Keyword(s):

Acute Stroke ◽

Stroke Care ◽

Acute Stroke Care

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Essential Acute Stroke Care in Low Resource Settings: a Pilot studY

Case Medical Research ◽

10.31525/ct1-nct04157231 ◽

2019 ◽

Author(s):

Keyword(s):

Pilot Study ◽

Acute Stroke ◽

Stroke Care ◽

Acute Stroke Care ◽

Low Resource Settings ◽

Low Resource

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Faculty Opinions recommendation of Provision of acute stroke care and associated factors in a multiethnic population: prospective study with the South London Stroke Register.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.8785964.9312066 ◽

2011 ◽

Author(s):

Erik Buskens

Keyword(s):

Prospective Study ◽

Acute Stroke ◽

Associated Factors ◽

Stroke Care ◽

The South ◽

Acute Stroke Care ◽

Multiethnic Population ◽

Stroke Register

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Bottlenecks in the Acute Stroke Care System during the COVID-19 Pandemic in Catalonia

Cerebrovascular Diseases ◽

10.1159/000516309 ◽

2021 ◽

pp. 1-9

Author(s):

Anna Ramos-Pachón ◽

Álvaro García-Tornel ◽

Mònica Millán ◽

Marc Ribó ◽

Sergi Amaro ◽

...

Keyword(s):

Acute Stroke ◽

Functional Outcome ◽

Stroke Care ◽

Care Quality ◽

Point Of View ◽

Stroke Severity ◽

Acute Stroke Care ◽

Vessel Occlusion ◽

Prehospital Delays ◽

The Impact

Introduction: The COVID-19 pandemic resulted in significant healthcare reorganizations, potentially striking standard medical care. We investigated the impact of the COVID-19 pandemic on acute stroke care quality and clinical outcomes to detect healthcare system’s bottlenecks from a territorial point of view. Methods: Crossed-data analysis between a prospective nation-based mandatory registry of acute stroke, Emergency Medical System (EMS) records, and daily incidence of COVID-19 in Catalonia (Spain). We included all stroke code activations during the pandemic (March 15–May 2, 2020) and an immediate prepandemic period (January 26–March 14, 2020). Primary outcomes were stroke code activations and reperfusion therapies in both periods. Secondary outcomes included clinical characteristics, workflow metrics, differences across types of stroke centers, correlation analysis between weekly EMS alerts, COVID-19 cases, and workflow metrics, and impact on mortality and clinical outcome at 90 days. Results: Stroke code activations decreased by 22% and reperfusion therapies dropped by 29% during the pandemic period, with no differences in age, stroke severity, or large vessel occlusion. Calls to EMS were handled 42 min later, and time from onset to hospital arrival increased by 53 min, with significant correlations between weekly COVID-19 cases and more EMS calls (rho = 0.81), less stroke code activations (rho = −0.37), and longer prehospital delays (rho = 0.25). Telestroke centers were afflicted with higher reductions in stroke code activations, reperfusion treatments, referrals to endovascular centers, and increased delays to thrombolytics. The independent odds of death increased (OR 1.6 [1.05–2.4], p 0.03) and good functional outcome decreased (mRS ≤2 at 90 days: OR 0.6 [0.4–0.9], p 0.015) during the pandemic period. Conclusion: During the COVID-19 pandemic, Catalonia’s stroke system’s weakest points were the delay to EMS alert and a decline of stroke code activations, reperfusion treatments, and interhospital transfers, mostly at local centers. Patients suffering an acute stroke during the pandemic period had higher odds of poor functional outcome and death. The complete stroke care system’s analysis is crucial to allocate resources appropriately.

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Acute Stroke Care during the COVID-19 Pandemic: Reduction in the Number of Admissions of Elderly Patients and Increase in Prehospital Delays

Cerebrovascular Diseases ◽

10.1159/000514140 ◽

2021 ◽

pp. 1-7

Author(s):

Gabriel Velilla-Alonso ◽

Andrés García-Pastor ◽

Ángela Rodríguez-López ◽

Ana Gómez-Roldós ◽

Antonio Sánchez-Soblechero ◽

...

Keyword(s):

Elderly Patients ◽

Acute Stroke ◽

Time Course ◽

Intravenous Thrombolysis ◽

Stroke Care ◽

Acute Stroke Care ◽

Group Data ◽

Radiological Data ◽

History Of ◽

Prehospital Delays

Introduction: We analyzed whether the coronavirus disease 2019 (COVID-19) crisis affected acute stroke care in our center during the first 2 months of lockdown in Spain. Methods: This is a single-center, retrospective study. We collected demographic, clinical, and radiological data; time course; and treatment of patients meeting the stroke unit admission criteria from March 14 to May 14, 2020 (COVID-19 period group). Data were compared with the same period in 2019 (pre-COVID-19 period group). Results: 195 patients were analyzed; 83 in the COVID-19 period group, resulting in a 26% decline of acute strokes and transient ischemic attacks (TIAs) admitted to our center compared with the previous year (p = 0.038). Ten patients (12%) tested positive for PCR SARS-CoV-2. The proportion of patients aged 65 years and over was lower in the COVID-19 period group (53 vs. 68.8%, p = 0.025). During the pandemic period, analyzed patients were more frequently smokers (27.7 vs. 10.7%, p = 0.002) and had less frequently history of prior stroke (13.3 vs. 25%, p = 0.043) or atrial fibrillation (9.6 vs. 25%, p = 0.006). ASPECTS score was lower (9 [7–10] vs. 10 [8–10], p = 0.032), NIHSS score was slightly higher (5 [2–14] vs. 4 [2–8], p = 0.122), onset-to-door time was higher (304 [93–760] vs. 197 [91.25–645] min, p = 0.104), and a lower proportion arrived within 4.5 h from onset of symptoms (43.4 vs. 58%, p = 0.043) during the COVID-19 period. There were no differences between proportion of patients receiving recanalization treatment (intravenous thrombolysis and/or mechanical thrombectomy) and in-hospital delays. Conclusion: We observed a reduction in the number of acute strokes and TIAs admitted during the COVID-19 period. This drop affected especially elderly patients, and despite a delay in their arrival to the emergency department, the proportion of patients treated with recanalization therapies was preserved.

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