Improving Knowledge About Stroke Using Simulation Training

 Door to needle time is way too slow! How EXACTLY are you going to get tPA delivered in 3 minutes post stroke?

Electrical 'storms' and 'flash floods' drown the brain after a stroke

 In this research in mice the needed time frame for tPA delivery is 3 minutes for full recovery.

The latest here:

Improving Knowledge About Stroke Using Simulation Training

Tanvi Ambulkar • Prachi Ambulkar • Anamika Saha • Jasmesh Sandhu • Alisha Gurung • Chris Jacobs

Published: December 05, 2024

DOI: 10.7759/cureus.75143

Peer-Reviewed

Cite this article as: Ambulkar T, Ambulkar P, Saha A, et al. (December 05, 2024) Improving Knowledge About Stroke Using Simulation Training. Cureus 16(12): e75143. doi:10.7759/cureus.75143

Abstract

Background

Stroke is a medical emergency that is risk-stratified using a national scoring system called the National Institute of Health Stroke Scale (NIHSS). The management of an acute stroke necessitates prompt management and swift decision-making. Human factors were identified in the literature as the main rate-limiting step to improving door-to-needle (DTN) time. We felt it would be prudent to design a local stroke course implemented at Great Western Hospital Swindon that incorporates both traditional and simulation-based elements to improve theoretical knowledge and emulate real-life scenarios. The objective of this course was to improve practical application in the efficient assessment and management of stroke patients, as this is critical to delivering timely treatment with thrombolysis or thrombectomy. 

Methods

Twenty-four medical professionals (medical students and resident doctors) participated in our course between November 2022 and July 2023. The domains assessed included understanding thrombolysis, understanding thrombectomy, confidence in performing NIHSS, and confidence in the assessment of stroke patients. The effectiveness of the stroke simulation course was assessed both quantitatively and qualitatively with pre- and post-course questionnaires.

Results

There was a significant improvement (p<0.05) in all four assessed domains. There was a significant increase (p=0.0003) in the mean difference of score 3.75 (95% CI: 2.43-5.07) in understanding thrombolysis. Similarly, understanding of thrombectomy was significantly improved (p=0.0002) with a mean difference in score of 3.4 (95% CI: 2.28-4.46). There was also a significant increase (p<0.0001) in confidence in completing NIHSS scoring by a mean of 4.33 (95% CI: 3.55-5.12). Lastly, there was a significant increase (p=0.0012) in the mean by 2.75 (95% CI: 1.51-3.99) in confidence in the assessment of stroke. Overall, 95.8% of the participants found the course at least good, if not very good or excellent, and 91.7% would recommend this course to others.

Conclusion

We found traditional and simulation-based training to be effective in improving understanding of thrombolysis, understanding of thrombectomy, confidence in NIHSS scoring, and confidence in the assessment of stroke patients. This study validates the effectiveness of our course in improving assessment and management in acute stroke patients. We infer that improvements in these domains coupled with simulation training focused on human factors (e.g., fatigue affecting decision-making or logistical issues such as delays in neuroimaging due to scanner availability) would achieve better DTN time in the participants of our course.

Introduction

Stroke is the second-leading cause of mortality after ischaemic heart disease (IHD) worldwide [1] and the fourth highest in England and Wales, causing 5.1% of all deaths in 2022 (0.8% increase compared to 2021) [2]. Stroke is also known to be a risk factor in the development of dementia [3,4] and Alzheimer's [5], which was the number one cause of mortality, accounting for 11.5% of registered deaths in England and Wales in 2022 [2]. In the United Kingdom, approximately 1.3 million are living with a stroke at an estimated cost of £26 billion per year, including £8.6 billion for the National Health Service (NHS) and social care [6]. Although reperfusion therapy (intravenous thrombolysis and mechanical thrombectomy) has shown promise in managing ischaemic stroke [7,8], the mainstay of clinical outcomes ultimately relies on a narrow time window to intervene [9,10]. This suggests that effective clinical assessment and swift decision-making are essential to reduce mortality, improve quality of life after a stroke, and reduce financial burden.

The National Stroke Service Model 2021 recommends an ideal door-to-needle (DTN) time of 20 minutes [11]. Level one evidence suggests simulation training reduces DTN time by approximately 15 minutes [12]. This is critical as every minute in cerebral ischaemia can cause a loss of up to 1.9 million neurons, which can result in irreversible neurological damage [13]. Since the human factor is the main rate-limiting step [14], we have designed a course incorporating both traditional and simulation-based training to improve participant confidence. The primary outcomes are to aid medical professionals in making an efficient assessment of patients with a suspected stroke, improving confidence in the National Institute of Health Stroke Scale (NIHSS) scoring, improving understanding of thrombolysis and thrombectomy, and hence reducing DTN time.(Needle time has to be before the hospital)