Selected abstracts from the 24th Annual Meeting of the Society in Europe for the Simulation Applied to Medicine

Abstract

R1 Simulation training in stroke thrombolysis: reducing door to needle times to less than 15 minutes Soffien Chadli Ajmi1,2,3, Rajiv Advani4,5, Lars Fjetland6,7, Kathinka D. Kurz6,7, Thomas Lindner8, Sigrun Qvindesland9, Hege Ersdal3,8, Martin W. Kurz1,2,10 1Department of Neurology, Stavanger University Hospital, Stavanger, Norway; 2Neuroscience Research Group, Stavanger University Hospital, Stavanger, Norway; 3Faculty of Health Sciences, University of Stavanger, Stavanger, Norway; 4Department of Neurology, Østfold Hospital, Kalnes, Norway; 5University Hospital and Faculty of Medicine, University of Bergen, Bergen, Norway; 6Department of Radiology, Stavanger University Hospital, Stavanger, Norway; 7Radiological Research Group, Stavanger University Hospital, Stavanger, Norway; 8Department of Anesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway; 9Stavanger Acute Medicine Foundation for Education and Research, Stavanger, Norway; 10Faculty of Medicine, University of Bergen, Bergen, Norway Correspondence: Soffien Chadli Ajmi (soffiena@yahoo.com) Ethics statement The authors declare that they have followed the guidelines for scientific integrity and professional ethics. The article does not contain any studies with human or animal subjects. Introduction & Aims Stroke is one of the leading causes of morbidity and mortality worldwide. In eligible patients with acute ischemic stroke, early treatment with intravenous thrombolysis is crucial for a good patient outcome. We introduced simulation training sessions in conjunction with an improved treatment protocol as part of a quality improvement project to reduce door-to-needle times in stroke thrombolysis. Methods A questionnaire assessing our preexisting treatment protocol was sent to all members of the stroke team. A panel of experts reviewed the responses and suggested potential changes to streamline the treatment protocol. In February 2017, we introduced the new protocol along with weekly videotaped in-situ scenario based simulation sessions with all stroke team members as participants. Previous stroke patients acted as markers. Kirkpatrick’s four-level training evaluation model was used for assessment. Here we present 1) Participant reactions (level 1) on a Likert item from 0-10, and 2) Median door-to-needle times in stroke thrombolysis, a measure of clinical behavioral change (level 3), using a statistical process control method. Simulated performance and long term patient outcomes will be assessed in future analysis. Results & Discussion Participant reactions were predominantly positive. Self-perceived learning scored a median of 8 (IQR 7-9). We compared door-to-needle times for 478 prospectively included patients with acute ischemic stroke treated with intravenous thrombolysis at our hospital from January 2014 – July 2017. There was a significant reduction in median door-to-needle time from 27 (IQR 19-41) to 13 minutes (IQR 9-21, p<0.001) for the 78 patients in the post-intervention group. The results remained significant regardless of time of admission. There were no significant changes in the rate of stroke mimics, prehospital time or fatal intracranial hemorrhage. Simulation training in conjunction with protocol improvement led to an immediate and significant reduction of median door-to-needle time in stroke thrombolysis (Fig. 1). To our knowledge, no other published data have shown lower median treatment times. Combining simulation training with protocol change holds promise as a method both for effective implementation and significant results in attempts to reduce in-hospital delays in stroke thrombolysis. Effects on non-technical skills, provider variability and long term patient outcomes are yet to be evaluated. Fig. 1 (abstract R1). figure1 Individual door-to-needle times with group medians before and after quality improvement Full size image