Background: The evaluation of acute ischemic stroke (AIS) patients should be performed expeditiously. Our stroke program maintained our Target: Stroke Honor Roll status in 2014, however, door-to-needle (DTN) time in Quarter 1 and 2 of 2015 showed no significant improvement and did not achieve DTN under 60 minutes in 75% of patients nor under 45 minutes in 50% of patients, despite in-servicing Emergency Department (ED)’s staff on program goals and order sets.
The purpose of this project was to more effectively educate emergency stroke responders on clinical recognition and implementation of the organization’s stroke protocol order sets. Simulation as an experiential learning technique, promoting, applied thinking, delegation, and leadership skills. Evidence suggests simulation based training for adult learners promote their engagement and immediate application of learned material.
Methods: Simulation: Stroke code responders, including 5 nurses per session, participated in the 90 minute scenario. Stroke protocol order sets were reviewed prior to the simulation of a right hemispheric syndrome. Participants elicited a focused history, National Institutes of Health Stroke Scale, relayed the findings to the neurologist, evaluate exclusion and inclusion criteria, and administered weight-based doses of tissue plasminogen activator (tPA). After a debrief, the participants repeated the simulation to reinforce new knowledge and skills. Descriptive statistics were used to compare mean DTN time before and after simulation training.
Results: 153 ED nurses, 8 ED physicians, 6 neurologists, 4 pharmacists, 6 radiology technicians, and 10 phlebotomists participated. Pre -training Q1-Q2 2015 median DTN was 55 minutes, 65% = 60 minutes, and 31% = 45 minutes. Post-training data from Q1 2016 median DTN was 46 minutes, 75% = 60 minutes, and 50% = 45 minutes.
Conclusion: Simulation based stroke responders training helped to decrease DTN time.