Introduction: In acute stroke, time equals brain. Minimizing time to treatment maximizes eligibility and effectiveness of fibrinolytics. Timely treatment of acute stroke requires precise coordination of a multidisciplinary team ranging from first responders to neurointerventionalists. Simulation-based learning allows participants to hone their skills and make mistakes in a controlled environment. To our knowledge, the impact of multidisciplinary stroke simulation has not been reported in literature. Here we describe our initial experience implementing such a simulation.
Hypothesis: Participation in stroke simulation will improve knowledge of acute stroke care guidelines and decrease door-to-needle time.
Methods: Neurology, emergency medicine and radiology trainees, EMTs, nurses, medical students, technologists, and pharmacists took part in the evaluation and treatment of simulated patients with stroke symptoms in actual clinical settings from ambulance to ED to CT scanner to IR suite. Neurology and neuroradiology faculty debriefed participants following simulations. Questions on stroke care (derived from the 2013 AHA/ASA guideline and 2015 update) were sent to likely participants before and after the simulation; those who completed pre/post quizzes and the simulation were included in analysis.
Results: Survey response rate was 86%. All participants had improved scores on the post-simulation quiz, scoring an average of 19% higher, 95% CI [8%, 29%]. For example, correct responses that IV tPA is not contraindicated prior to endovascular therapy improved from 64 to 100% after the simulation; responses correctly identifying the appearance of ischemic penumbra on CT perfusion imaging increased from 27 to 73%. Nearly all (92%) respondents would recommend the simulation to their peers.
Conclusions: Simulation of acute stroke scenarios improves participants’ knowledge of acute stroke management guidelines and may improve door-to-needle time. We present a novel framework for multidisciplinary simulation, which could be implemented at other institutions. Further evaluation of simulation effect on door-to-needle time is ongoing.