Background:
City-wide re-organisation of stroke care in London, incorporating 8 hyperacute stroke units (HASUs), has improved thrombolysis rates and survival cost-effectively. Continued staffing of HASUs requires stroke-specialist training to develop competencies for managing neurological emergencies. Simulation training provides an education platform for health care professionals to become immersed in realistic scenarios where outcome is dependent upon technical and non-technical skills.
Methods:
A standardised, curriculum-mapped, high-fidelity, simulation-training programme was developed on 4 HASUs for city-wide staff to attend. Learning outcomes included technical (acute stroke assessment/management) and non-technical skills (including time management/decision-making/teamwork). A mixed-methods evaluation approach was used to evaluate data from participants before, during, and after training.
Results:
Over a 2 year period, 152 HASU staff (70 medical; 82 nursing) participated. Quantitative analysis showed a pre/post-course increase in candidates’ ability to manage emergency stroke situations (t=6.6, p<0.001), leadership skills (t=6.7, p<0.001) and communication skills (t=3.7, p<0.001), more so in junior compared with senior clinicians. Simulation training was enjoyable (mean (SD) rating 5.7(2) on 7 point Likert scale), with higher ratings from doctors compared with nurses (t=3; p<0.01). Enjoyment correlated positively (r=0.853; p<0.001) and previous experience of simulation correlated negatively (r=-0.228; p<0.05) with relevance to clinical practice. Thematic analysis of post-course semi-structured interviews demonstrated 5 important learning outcomes (assertiveness; calling for help; situational awareness; teamwork; verbalising thoughts) and 3 main responses for transference to practice (general enthusiasm with no particular practical change; immediate recognition of an emergency situation providing recall of the course; reflective change).
Conclusion:
Simulation training may be effective in helping achieve HASU-specific learning outcomes and may be delivered in a standardised manner across multiple sites.
Impact of COVID-19 on Stroke Caseload in a Major Hyperacute Stroke Unit
