Simulation-based training improves process times in acute stroke care (STREAM).

Fibrinolytic Agents / therapeutic use Humans Prospective Studies Simulation Training Stroke / drug therapy Thrombolytic Therapy / adverse effects Time-to-Treatment Treatment Outcome
CRM simulation stroke thrombolysis training

Journal

European journal of neurology
ISSN: 1468-1331
Titre abrégé: Eur J Neurol
Pays: England
ID NLM: 9506311

Informations de publication

Date de publication:
01 2022
Historique:
revised: 29 08 2021
received: 04 07 2021
accepted: 30 08 2021
pubmed: 4 9 2021
medline: 5 4 2022
entrez: 3 9 2021
Statut: ppublish

Résumé

The objective of the STREAM Trial was to evaluate the effect of simulation training on process times in acute stroke care. The multicenter prospective interventional STREAM Trial was conducted between 10/2017 and 04/2019 at seven tertiary care neurocenters in Germany with a pre- and post-interventional observation phase. We recorded patient characteristics, acute stroke care process times, stroke team composition and simulation experience for consecutive direct-to-center patients receiving intravenous thrombolysis (IVT) and/or endovascular therapy (EVT). The intervention consisted of a composite intervention centered around stroke-specific in situ simulation training. Primary outcome measure was the 'door-to-needle' time (DTN) for IVT. Secondary outcome measures included process times of EVT and measures taken to streamline the pre-existing treatment algorithm. The effect of the STREAM intervention on the process times of all acute stroke operations was neutral. However, secondary analyses showed a DTN reduction of 5 min from 38 min pre-intervention (interquartile range [IQR] 25-43 min) to 33 min (IQR 23-39 min, p = 0.03) post-intervention achieved by simulation-experienced stroke teams. Concerning EVT, we found significantly shorter door-to-groin times in patients who were treated by teams with simulation experience as compared to simulation-naive teams in the post-interventional phase (-21 min, simulation-naive: 95 min, IQR 69-111 vs. simulation-experienced: 74 min, IQR 51-92, p = 0.04). An intervention combining workflow refinement and simulation-based stroke team training has the potential to improve process times in acute stroke care.

Sections du résumé

BACKGROUND
The objective of the STREAM Trial was to evaluate the effect of simulation training on process times in acute stroke care.
METHODS
The multicenter prospective interventional STREAM Trial was conducted between 10/2017 and 04/2019 at seven tertiary care neurocenters in Germany with a pre- and post-interventional observation phase. We recorded patient characteristics, acute stroke care process times, stroke team composition and simulation experience for consecutive direct-to-center patients receiving intravenous thrombolysis (IVT) and/or endovascular therapy (EVT). The intervention consisted of a composite intervention centered around stroke-specific in situ simulation training. Primary outcome measure was the 'door-to-needle' time (DTN) for IVT. Secondary outcome measures included process times of EVT and measures taken to streamline the pre-existing treatment algorithm.
RESULTS
The effect of the STREAM intervention on the process times of all acute stroke operations was neutral. However, secondary analyses showed a DTN reduction of 5 min from 38 min pre-intervention (interquartile range [IQR] 25-43 min) to 33 min (IQR 23-39 min, p = 0.03) post-intervention achieved by simulation-experienced stroke teams. Concerning EVT, we found significantly shorter door-to-groin times in patients who were treated by teams with simulation experience as compared to simulation-naive teams in the post-interventional phase (-21 min, simulation-naive: 95 min, IQR 69-111 vs. simulation-experienced: 74 min, IQR 51-92, p = 0.04).
CONCLUSION
An intervention combining workflow refinement and simulation-based stroke team training has the potential to improve process times in acute stroke care.

Identifiants

DOI: 10.1111/ene.15093 PMID: 34478596
pubmed: 34478596
doi: 10.1111/ene.15093
doi:

Substances chimiques

Fibrinolytic Agents 0

Banques de données

ClinicalTrials.gov
['NCT03228251']

Types de publication

Journal Article Multicenter Study Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

138-148

Informations de copyright

© 2021 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.

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Auteurs

Ferdinand O Bohmann (FO)

Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.
ORCID: 0000-0001-6439-0667

Katharina Gruber (K)

Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.

Natalia Kurka (N)

Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.

Laurent M Willems (LM)

Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.

Eva Herrmann (E)

Faculty of Medicine, Institute of Biostatistics and Mathematical Modelling, Goethe University, Frankfurt am Main, Germany.

Richard du Mesnil de Rochemont (R)

Institute for Diagnostic and Interventional Neuroradiology, University Hospital Frankfurt, Frankfurt am Main, Germany.

Peter Scholz (P)

NICU Nursing Staff, University Hospital Frankfurt, Frankfurt am Main, Germany.

Heike Rai (H)

Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.

Philipp Zickler (P)

Department of Neurology and Clinical Neurophysiology, University Hospital Augsburg, Augsburg, Germany.

Michael Ertl (M)

Department of Neurology and Clinical Neurophysiology, University Hospital Augsburg, Augsburg, Germany.
ORCID: 0000-0001-5271-4898

Ansgar Berlis (A)

Department for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Germany.

Sven Poli (S)

Department of Neurology and Stroke, University Hospital Tübingen, Tübingen, Germany.
Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.

Annerose Mengel (A)

Department of Neurology and Stroke, University Hospital Tübingen, Tübingen, Germany.
Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.

Peter Ringleb (P)

Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany.

Simon Nagel (S)

Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany.
ORCID: 0000-0003-2471-6647

Johannes Pfaff (J)

Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany.
ORCID: 0000-0003-0672-5718

Frank A Wollenweber (FA)

Department of Neurology, Ludwig Maximilians-University Munich, Munich, Germany.
Department of Neurology, Helios-HSK Wiesbaden, Wiesbaden, Germany.

Lars Kellert (L)

Department of Neurology, Ludwig Maximilians-University Munich, Munich, Germany.
ORCID: 0000-0002-4967-8336

Moriz Herzberg (M)

Department for Diagnostic and Interventional Neuroradiology, Ludwig Maximilians-University Munich, Munich, Germany.
Department of Diagnostic and Interventional Radiology, Universitätsklinikum Würzburg, Würzburg, Germany.
ORCID: 0000-0002-8799-9333

Luzie Koehler (L)

Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Department of Neurology, University Hospital Leipzig, Leipzig, Germany.

Karl Georg Haeusler (KG)

Department of Neurology, Universitätsklinikum Würzburg, Würzburg, Germany.

Anna Alegiani (A)

Department of Neurology, University Medical Center Hamburg Eppendorf, Hamburg, Germany.
ORCID: 0000-0001-8216-6220

Charlotte Schubert (C)

Department of Neurology, University Medical Center Hamburg Eppendorf, Hamburg, Germany.

Caspar Brekenfeld (C)

Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany.

Christopher E J Doppler (CEJ)

Department of Neurology, Faculty of Medicine and University Hospital Cologne, University Cologne, Cologne, Germany.

Özgür A Onur (ÖA)

Department of Neurology, Faculty of Medicine and University Hospital Cologne, University Cologne, Cologne, Germany.

Christoph Kabbasch (C)

Department of Neuroradiology, Faculty of Medicine and University Hospital Cologne, University Cologne, Cologne, Germany.

Tanja Manser (T)

School of Applied Psychology, FHNW University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland.

Helmuth Steinmetz (H)

Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.

Waltraud Pfeilschifter (W)

Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.
Department of Neurology and Clinical Neurophysiology, Städtisches Klinikum Lüneburg, Lüneburg, Germany.
ORCID: 0000-0001-6935-8842

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Classifications MeSH

questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents hématologiques › Fibrinolytiques › Simulation-based training improves process...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Simulation-based training improves process...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Simulation-based training improves process...
questionsmedicales.fr › Éducation › Enseignement › Formation par simulation › Simulation-based training improves process...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Accident vasculaire cérébral › Simulation-based training improves process...
questionsmedicales.fr › Thérapeutique › Traitement médicamenteux › Traitement thrombolytique › Simulation-based training improves process...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Délai jusqu'au traitement › Simulation-based training improves process...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Simulation-based training improves process...