Abstract WP295: Improving Resident Confidence and Efficiency During Stroke Alerts Through Simulation Training

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Abstract

Background: While most institutions have mock simulations for a code blue or rapid response, there is no standard practice for stroke alert simulations to train neurology residents. This causes residents to feel less confident and take longer when responding to stroke alerts and giving tPA.

Objectives: The first objective was to teach incoming neurology residents how to respond efficiently and appropriately to a stroke alert. Second, we wanted to improve the confidence level of residents during stroke alerts.

Methods: The training session began with a one hour didactic session on how to respond to stroke alerts and when to appropriately administer tPA. A second hour of training focused on how to perform the NIH stroke scale (NIHSS). The following day, nine residents each participated in two stroke simulations utilizing standardized patients. They were observed by an attending, fellow, or resident via video monitoring to ensure accurate history taking and correct NIHSS performance. The residents reviewed head CT imaging and determined if tPA would be given. If tPA was deemed appropriate, the residents notified pharmacy and explained the risks and benefits of the medication to the standardized patient. There was then an immediate feedback session to review particular areas for improvement. The residents completed pre- and post- simulation tests to assess stroke knowledge and to determine confidence in responding to stroke alerts.

Results: Prior to the stroke lecture and simulation, 44% of residents reported confidence responding to a stroke alert. After the simulation, 78% of residents felt confident. Only 44% of residents felt confident performing an NIHSS prior to the simulation versus 100% after the simulation. The number of residents who felt confident in their decision-making ability to give tPA increased from 22% to 56% after the simulation.

Conclusion: In conclusion, residents were more confident responding to stroke alerts, performing an NIHSS, and deciding to give tPA after completing both the didactic stroke training and simulation cases. Data is also being analyzed to determine if the simulations had an effect on resident efficiency during stroke alerts by comparing door to needle time before and after the simulations.

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