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Front Neurol. 2019 Sep 11;10:969. doi: 10.3389/fneur.2019.00969. eCollection 2019.

Simulation-Based Training of the Rapid Evaluation and Management of Acute Stroke (STREAM)-A Prospective Single-Arm Multicenter Trial.

Author information

1
Department of Neurology, University Hospital Frankfurt, Frankfurt, Germany.
2
Institute for Diagnostic and Interventional Neuroradiology, University Hospital Frankfurt, Frankfurt, Germany.
3
Department of Neurology, Klinikum Hanau, Hanau, Germany.
4
NICU Nursing Staff, University Hospital Frankfurt, Frankfurt, Germany.
5
Department of Neurology and Clinical Neurophysiology, Universitätsklinikum Augsburg, Augsburg, Germany.
6
Department for Diagnostic and Interventional Radiology and Neuroradiology, Universitätsklinikum Augsburg, Augsburg, Germany.
7
Department of Neurology With Focus on Neurovascular Diseases and Neurooncology, University Hospital Tübingen, Tübingen, Germany.
8
Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.
9
Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany.
10
Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany.
11
Department of Neurology, Ludwig Maximilians-University, Munich, Germany.
12
Department for Diagnostic and Interventional Neuroradiology, Ludwig Maximilians-University, Munich, Germany.
13
Department of Neurology, University Hospital Leipzig, Leipzig, Germany.
14
Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.
15
Department of Neurology, Universitätsklinikum Würzburg, Würzburg, Germany.
16
Department of Neurology, University Medical Centre Hamburg Eppendorf, Hamburg, Germany.
17
Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Hamburg Eppendorf, Hamburg, Germany.
18
Department of Neurology, University Hospital Cologne, Cologne, Germany.
19
Department of Neuroradiology, University Hospital Cologne, Cologne, Germany.
20
School of Applied Psychology, FHNW University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland.

Abstract

Introduction: Acute stroke care delivered by interdisciplinary teams is time-sensitive. Simulation-based team training is a promising tool to improve team performance in medical operations. It has the potential to improve process times, team communication, patient safety, and staff satisfaction. We aim to assess whether a multi-level approach consisting of a stringent workflow revision based on peer-to-peer review and 2-3 one-day in situ simulation trainings can improve acute stroke care processing times in high volume neurocenters within a 6 months period. Methods and Analysis: The trial is being carried out in a pre-test-post-test design at 7 tertiary care university hospital neurocenters in Germany. The intervention is directed at the interdisciplinary multiprofessional stroke teams. Before and after the intervention, process times of all direct-to-center stroke patients receiving IV thrombolysis (IVT) and/or endovascular therapy (EVT) will be recorded. The primary outcome measure will be the "door-to-needle" time of all consecutive stroke patients directly admitted to the neurocenters who receive IVT. Secondary outcome measures will be intervention-related process times of the fraction of patients undergoing EVT and effects on team communication, perceived patient safety, and staff satisfaction via a staff questionnaire. Interventions: We are applying a multi-level intervention in cooperation with three "STREAM multipliers" from each center. First step is a central meeting of the multipliers at the sponsor's institution with the purposes of algorithm review in a peer-to-peer process that is recorded in a protocol and an introduction to the principles of simulation training and debriefing as well as crew resource management and team communication. Thereafter, the multipliers cooperate with the stroke team trainers from the sponsor's institution to plan and execute 2-3 one-day simulation courses in situ in the emergency department and CT room of the trial centers whereupon they receive teaching materials to perpetuate the trainings. Clinical Trial Registration: STREAM is a registered trial at https://clinicaltrials.gov/ct2/show/NCT03228251.

KEYWORDS:

CRM; emergency care; simulation training; stroke; thrombolysis (tPA)

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