Abstract WP259: Simulation Based Medical Education in Interprofessional Education: Acute Stroke Management Model

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Brett Johnson ◽  
Leann Horsley ◽  
Trent Reed ◽  
Donna Quinones ◽  
Viva Siddall ◽  
...  
Keyword(s):  
Medical Education ◽  
Medical Students ◽  
Acute Stroke ◽  
Team Performance ◽  
Interprofessional Education ◽  
Stroke Care ◽  
Stroke Management ◽  
Acute Stroke Care ◽  
Stroke Team ◽  
Simulation Based

Introduction: Simulation-based medical education (SBME) is an established tool for training and certifying providers for critical situations such as ACLS. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is a program developed by the Agency for Healthcare Research and Quality and the Department of Defense to improve teamwork. Previous work has demonstrated the effectiveness of SBME in stroke team performance among neurology residents and ICU nurses. Our aim was to develop an SBME interprofessional education (IPE) program for nursing and medical students on stroke team performance. Method: Using a quantitative descriptive one group pretest/posttest design, acute stroke care (14 items), TeamSTEPPS knowledge (14 items) and attitudes toward IPE (16 items) were assessed. After the initial survey, students were given modules on acute stroke care and TeamSTEPPS. Students were randomly assigned into small mixed groups before participating in 2 high-fidelity simulations: an IV tPA-eligible ischemic stroke and a warfarin-associated ICH requiring INR reversal. During each case, trained faculty assessed students using a standardized checklist focusing on stroke management and teamwork. Faculty underwent inter-rater reliability and recalibration training prior to participation. A standardized debriefing was conducted immediately after each case. A 1-hour reinforced learning session was provided by physician and nursing experts in stroke and TeamSTEPPS between cases. Result: 65 nursing and 26 medical students participated. Improvement was seen in the cognitive assessment ( p <0.0001 for composite score) and each affective item ( p <0.0001) after SBME. Psychomotor scores improved ( p <0.01) in most items on the team performance checklist and improved for 5 items on the stroke task checklist. Conclusion: SBME is feasible and effective for supporting IPE in team-based stroke training among nursing and medical students. Although impact on real-world metrics such as door-to-needle time and protocol deviation remains uncertain, SBME using TeamSTEPPS principles should be incorporated within stroke education curricula. Moreover, a stroke code certification process similar to ACLS should be contemplated.

scholarly journals Measuring Patient Safety Climate in Acute Stroke Therapy

2021 ◽  
Vol 12 ◽  
Author(s):  
Ferdinand O. Bohmann ◽  
Joachim Guenther ◽  
Katharina Gruber ◽  
Tanja Manser ◽  
Helmuth Steinmetz ◽  
...  
Keyword(s):  
Patient Safety ◽  
Acute Stroke ◽  
Safety Climate ◽  
Stroke Care ◽  
University Hospitals ◽  
Acute Stroke Care ◽  
Safety Attitudes ◽  
Patient Safety Climate ◽  
Stroke Team ◽  
First Time

Background: Treatment of acute stroke is highly time-dependent and performed by a multiprofessional, interdisciplinary team. Interface problems are expectable and issues relevant to patient safety are omnipresent. The Safety Attitudes Questionnaire (SAQ) is a validated and widely used instrument to measure patient safety climate. The objective of this study was to evaluate the SAQ for the first time in the context of acute stroke care.Methods: A survey was carried out during the STREAM trial (NCT 032282) at seven university hospitals in Germany from October 2017 to October 2018. The anonymous survey included 33 questions (5-point Likert scale, 1 = disagree to 5 = agree) and addressed the entire multiprofessional stroke team. Statistical analyses were used to examine psychometric properties as well as descriptive findings.Results: 164 questionnaires were completed yielding a response rate of 66.4%. 67.7% of respondents were physicians and 25.0% were nurses. Confirmatory Factor Analysis revealed that the original 6-factor structure fits the data adequately. The SAQ for acute stroke care showed strong internal consistency (α = 0.88). Exploratory analysis revealed differences in scores on the SAQ dimensions when comparing physicians to nurses and when comparing physicians according to their duration of professional experience.Conclusion: The SAQ is a helpful and well-applicable tool to measure patient safety in acute stroke care. In comparison to other high-risk fields in medicine, patient safety climate in acute stroke care seems to be on a similar level with the potential for further improvements.Trial registration:www.ClinicalTrials.gov Identifier: NCT032282.

Abstract WMP68: Smartphone Support System for Mobile Imaging Display and Management of Acute Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Kristina Shkirkova ◽  
Eftitan Y Akam ◽  
Josephine F Huang ◽  
Sunil A Sheth ◽  
May Nour ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Stroke Care ◽  
Final Diagnosis ◽  
Integrated System ◽  
Ease Of Use ◽  
Imaging Data ◽  
Acute Stroke Care ◽  
Team Members ◽  
Information Platform ◽  
Stroke Team

Introduction: Rapid dissemination and coordination of clinical and imaging data among multidisciplinary team members is essential for optimal acute stroke care. Standard desktop EMRs are ill-suited for this purpose, but mobile smartphone and tablet applications are highly promising platforms for accelerated, data-driven patient diagnosis and treatment. This study tested an advanced mobile integrated system for distribution of patient clinical and imaging information. Methods: We tested the iStroke/Synapse ERm system (Figure) for smartphone and tablet display and integration of clinical data, CT, MR, and catheter angiographic imaging, and real-time stroke team communications, in consecutive acute neurovascular patients at a Comprehensive Stroke Center. Results: From 5/2014 to 10/2014, the Synapse ERm application was installed and used by 33 stroke team members, in 84 Code Stroke ED patients. Patient age was 69.1 (±17.5), with 40.5% female. Final diagnosis was: ischemic stroke 66%, TIA 7%, ICH 6%, and CV mimic 21%. Each patient record was viewed on average 13 times by at least 3 team members. The most used feature was CT, MR and cath angio image display, viewed on average 4 times per patient by at least 2 users. In-app tweet team communications were sent by average 2 users per case and viewed by average 6 team members. Use of the system was associated with treatment times that exceeded national guideline targets for thrombolysis and endovascular thrombectomy, including door-to-needle 50 min (IQR 24-60) and door-to-groin 92 min (IQR 65-128). In user surveys, the mobile information platform was judged easy to employ in 91% of uses and of added help in stroke management in a substantial majority of cases. Conclusion: The Synapse ERm system, a smartphone/tablet platform for stroke team communication and distribution and integration of clinical and imaging data, showed high ease of use, substantial added management value, and association with rapid processes of care.

Abstract TP240: Simulation-Based Learning Improves Neurology Resident Training in Acute Stroke Care

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Waimei Tai ◽  
J.j. Baumann ◽  
Esther Melamed ◽  
Nirali Vora ◽  
Neil Schwartz
Keyword(s):  
Acute Stroke ◽  
Training Session ◽  
Vital Signs ◽  
Stroke Care ◽  
Resident Training ◽  
Acute Stroke Care ◽  
Simulation Based ◽  
Overall Evaluation ◽  
Simulation Center

Introduction: Acute “stroke codes” are stressful for the new neurology resident who must lead a multi-disciplinary team and quickly integrate information to make high risk time-sensitive decisions. While other disciplines have used simulation technology for years for cardiac arrest codes, neurology has just begun utilizing this resource. Objective: To improve neurology trainees’ execution of a multi-disciplinary acute stroke code using simulation experience Methods: We identified three learning objectives for the simulation experience: assess tissue plasminogen activator (tPA) eligibility, utilize appropriate order sets, and communicate effectively. Scripts for two emergent scenarios were developed: ischemic stroke requiring i.v. tPA and warfarin-associated intracranial hemorrhage requiring coagulopathy reversal. A standardized patient (SP) was trained. Neurology residents in their first week of training were the learners. Six residents attended a four-hour training session in the Simulation Center at Stanford University. Half of the trainees participated in the scenario while the others observed through live video. The SP acted the part in a fully-equipped, mock emergency room. Monitors, controlled remotely, displayed vital signs which changed to reflect interventions performed. Screens also displayed radiologic data. Trainees communicated with the stroke fellow and nursing regarding the plan of care and placed orders through an electronic medical record in training mode. Debriefing occurred after each scenario. Evaluations were completed and collected. Results: Trainees had positive experiences and felt more comfortable with the stroke code after the training. On a 1-5 scale, learners rated quality of teaching (average 4.6); learning from the scenario (4.8); overall organization (4.2); facilities (5); and overall evaluation (4.6). Conclusions: Simulation training offers a valuable opportunity to enhance neurology resident’s comfort in running stroke codes. Additional studies are required to measure long-term retention of acquired skills and training effect on systems and clinical outcomes.

scholarly journals The role of cardiologists on the stroke unit

2020 ◽  
Vol 22 (Supplement_M) ◽  
pp. M3-M12
Author(s):  
Wolfram Doehner ◽  
David Manuel Leistner ◽  
Heinrich J Audebert ◽  
Jan F Scheitz
Keyword(s):  
Acute Stroke ◽  
Stroke Unit ◽  
Stroke Care ◽  
Cardiovascular Complications ◽  
Large Artery ◽  
Stroke Management ◽  
Acute Stroke Care ◽  
Daily Work ◽  
Cardiovascular Comorbidity ◽  
Treatment And Prevention

Abstract Cardiologists need a better understanding of stroke and of cardiac implications in modern stroke management. Stroke is a leading disease in terms of mortality and disability in our society. Up to half of ischaemic strokes are directly related to cardiac and large artery diseases and cardiovascular risk factors are involved in most other strokes. Moreover, in an acute stroke direct central brain signals and a consecutive autonomic/vegetative imbalance may account for severe and life-threatening cardiovascular complications. The strong cerebro-cardiac link in acute stroke has recently been addressed as the stroke-heart syndrome that requires careful cardiovascular monitoring and immediate therapeutic measures. The regular involvement of cardiologic expertise in daily work on a stroke unit is therefore of high importance and a cornerstone of up-to-date comprehensive stroke care concepts. The main targets of the cardiologists’ contribution to acute stroke care can be categorized in three main areas (i) diagnostics workup of stroke aetiology, (ii) treatment and prevention of complications, and (iii) secondary prevention and sub-acute workup of cardiovascular comorbidity. All three aspects are by themselves highly relevant to support optimal acute management and to improve the short-term and long-term outcomes of patients. In this article, an overview is provided on these main targets of cardiologists’ contribution to acute stroke management.

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

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.

Abstract 115: Current Status of Acute Stroke Management in Korea: A Nationwide Report Based on 19,608 Patients Treated in 216 Hospitals

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Jun Yup Kim ◽  
Keon-Joo Lee ◽  
Jihoon Kang ◽  
Beom Joon Kim ◽  
Seong-Eun Kim ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Stroke Unit ◽  
National Level ◽  
Stroke Care ◽  
Current Status ◽  
Endovascular Coiling ◽  
Stroke Management ◽  
Acute Stroke Care ◽  
Survey Period ◽  
Stroke Units

Introduction: There have been few reports on status of acute stroke management at a national level worldwide, and none in Korea. This study is aimed to describe the current status and disparities of acute stroke management in Korea. Methods: Data from 5th (2013) and 6th (2014) national surveys for assessing quality of acute stroke care were used. Patients with principal diagnosis codes indicating subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), ischemic stroke (IS), who were admitted via emergency rooms within 7 days of onset at hospitals treating 10 or more stroke cases during the each 3-month survey period were selected. Results: A total of 19,608 stroke cases (age, 67.7±13.5years; female, 45%; IS, 76%; ICH, 15%; SAH, 9%) treated in 216 hospitals were analyzed. Thirty-one percent of hospitals had stroke units and 41% of stroke cases were treated at hospitals without stroke units. In IS, IV thrombolysis (IVT) and endovascular treatment (EVT) rates were 10.7% and 3.6%, respectively. Thirty-nine percent of IVT and fifty-two percent of EVT cases were performed in hospitals with annual volume of <25 IVT and <15 EVT. Centralization of EVT showed disparities by region (Figure). Carotid endarterectomy, carotid artery stenting, decompressive, bypass surgery was conducted in 0.2%, 1.4%, 1.0%, 0.2% of IS cases; decompressive surgery was done in 28.1% of ICH cases; surgical clipping, endovascular coiling was done in 17.2%, 14.3% of SAH cases, respectively. There were noticeable regional disparities in various interventions, use of ambulance, arrival time and provision of stroke unit service. Conclusions: This study is the first report on the status of acute stroke care in Korea on a national level. Large number of recanalization therapies were performed in low-volume-hospitals. Expansion of stroke unit service, stroke center certification or accreditation, and connections between stroke centers and EMS are highly recommended.

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

Stroke ◽  
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.

scholarly journals Current Status and Issues of Acute Stroke Management in Korea: Results of a Nationwide Acute Stroke Care Hospital Survey

2019 ◽  
Vol 37 (1) ◽  
pp. 38-46
Author(s):  
Jong-Ho Park ◽  
Bum-Joon Kim ◽  
Cindy W Yoon ◽  
Joung-Ho Rha ◽  
Ji Hoe Heo ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Stroke Care ◽  
Current Status ◽  
Care Hospital ◽  
Stroke Management ◽  
Acute Stroke Care

scholarly journals Effect of COVID-19 on Emergent Stroke Care

Stroke ◽  
2020 ◽  
Vol 51 (9) ◽  
Author(s):  
Jessica Hsiao ◽  
Emily Sayles ◽  
Eleni Antzoulatos ◽  
Robert J. Stanton ◽  
Heidi Sucharew ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Stroke Care ◽  
Mitigation Measures ◽  
Acute Stroke Care ◽  
Healthcare Facilities ◽  
Stroke Team ◽  
Before And After ◽  
Prior Stroke ◽  
Hospital Capacities ◽  
Mortality Analysis

Background and Purpose: Anecdotal evidence suggests that the coronavirus disease 2019 (COVID-19) pandemic mitigation efforts may inadvertently discourage patients from seeking treatment for stroke with resultant increased morbidity and mortality. Analysis of regional data, while hospital capacities for acute stroke care remained fully available, offers an opportunity to assess this. We report regional Stroke Team acute activations and reperfusion treatments during COVID-19 mitigation activities. Methods: Using case log data prospectively collected by a Stroke Team exclusively serving ≈2 million inhabitants and 30 healthcare facilities, we retrospectively reviewed volumes of consultations and reperfusion treatments for acute ischemic stroke. We compared volumes before and after announcements of COVID-19 mitigation measures and the prior calendar year. Results: Compared with the 10 weeks prior, stroke consultations declined by 39% (95% CI, 32%–46%) in the 5 weeks after announcement of statewide school and restaurant closures in Ohio, Kentucky, and Indiana. Results compared with the prior year and time trend analyses were consistent. Reperfusion treatments also appeared to decline by 31% (95% CI, 3%–51%), and specifically thrombolysis by 33% (95% CI, 4%–55%), but this finding had less precision. Conclusions: Upon the announcement of measures to mitigate COVID-19, regional acute stroke consultations declined significantly. Reperfusion treatment rates, particularly thrombolysis, also appeared to decline qualitatively, and this finding requires further study. Urgent public education is necessary to mitigate a possible crisis of avoiding essential emergency care due to COVID-19.

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