Abstract WP397: Multidisciplinary Simulation of Stroke Alerts in Resident Education Leads to a 20% Decrease in Door to Needle Times

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Introduction: Neurology residents are primarily responsible for responding to stroke alerts within our institution. It is imperative that first year residents understand the process and role expectations are clearly defined. Historically, residents were expected to run a stroke alert without having formal education on the stroke alert process.Hypothesis: Giving residents timely education of the stroke alert process will lead to decreased door to needle times.Methods: In July 2015, the Clinical Nurse Specialist (CNS) identified that simulation based learning (SBL) would close this gap. Scenarios were developed in collaboration with a Vascular attending and fellow. Emergency department nurses, EMS, chaplains, and pharmacist all participated in the scenario to make it as realistic as possible. A mannequin was utilized and controlled by simulation lab personnel while participants were videotaped as they performed the scenario. Incorporated into the debriefing of the scenario was education of door to needle goals, stroke alert process, and a discussion of role expectations.Results: In FY2014, the average door to needle was 49.5 minutes. After providing simulation education to residents, the door to needle (DTN) average decreased to 39.8 minutes with a p-value of 0.0794. Before the education we met the goal of administering Alteplase in less than 60 minutes, 80% of the time. Following the education we met the goal 89% of the time. Improvement also occurred with the DTN goal of less than 45 minutes from FY2014 to FY2015, 51.5% and 59.2% respectively.Conclusion: Education of residents in a SBL environment prior to their stroke rotation led to a 20% decrease in door to needle times. Although results did not meet statistical significance, this reduction in DTN time is clinically significant as evidence has shown shorter DTN association with improved outcomes. Anecdotally, residents expressed increased confidence in running a stroke alert and understood the DTN goals.

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