A resident boot camp for reducing door-to-needle times at academic medical centers

Ruff, Ilana; Liberman, Ava L; Caprio, Fan Z.; Maas, Matthew B.; Mendelson, Scott; Sorond, Farzaneh A.; Bergman, Deborah; Bernstein, Richard A.; Curran, Yvonne

doi:10.1212/cpj.0000000000000367

Cited by 21 publications

(20 citation statements)

References 21 publications

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“…Additional individual resident feedback sessions were also available throughout the year. In a study by Ruff et al a formal case-based clinical “boot camp” for incoming junior neurology residents resulted in 25 min DNT reduction in patients managed by junior staff ( 20 ). Other centers have also incorporated regular feedback and education sessions as an ongoing feature of the stroke pathway ( 5 , 14 , 21 ).…”

Section: Discussionmentioning

confidence: 99%

Helsinki Stroke Model Is Transferrable With “Real-World” Resources and Reduced Stroke Thrombolysis Delay to 34 min in Christchurch

Coleman

Wright

et al. 2018

Front. Neurol.

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BackgroundChristchurch hospital is a tertiary hospital in New Zealand supported by five general neurologists with after-hours services provided mainly by onsite non-neurology medical residents. We assessed the transferrability and impact of the Helsinki Stroke model on stroke thrombolysis door-to-needle time (DNT) in Christchurch hospital.MethodsKey components of the Helsinki Stroke model were implemented first in 2015 with introduction of patient pre-notification and thrombolysis by the computed tomography (CT) suite, followed by implementation of direct transfer to CT on ambulance stretcher in May 2017. Data from the prospective thrombolysis registry which began in 2012 were analyzed for the impact of these interventions on median DNT.ResultsBetween May and December 2017, 46 patients were treated with alteplase, 25 (54%) patients were treated in-hours (08:00–17:00 non-public holiday weekdays) and 21 (46%) patients were treated after-hours. The in-hours, after-hours, and overall median (interquartile range) DNTs were 34 (28–43), 47 (38–60), and 40 (30–51) minutes. The corresponding times in 2012–2014 prior to interventions were 87 (68–106), 86 (72–116), and 87 (71–112) minutes, representing median DNT reduction of 53, 39, and 47 minutes, respectively (p-values <0.01). The interventions also resulted in significant reductions in the overall median door-to-CT time (from 49 to 19 min), CT-to-needle time (32 to 20 min) and onset-to-needle time (168 to 120 min).ConclusionThe Helsinki stroke model is transferrable with real-world resources and reduced stroke DNT in Christchurch by over 50%.

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Section: Discussionmentioning

confidence: 99%

Helsinki Stroke Model Is Transferrable With “Real-World” Resources and Reduced Stroke Thrombolysis Delay to 34 min in Christchurch

Coleman

Wright

et al. 2018

Front. Neurol.

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“…The importance of training for interprofessional work is re ected in a training study aimed only at neurology residents, which shows how training allows the reduction of treatment times when patients are left in charge of neurology residents, but maintaining the times from when the patient enters the hospital to the activation of the stroke code and until imaging, processes in charge of the emergency departments, which had not been trained. (13) Finally, it is relevant to highlight the high acceptance of professionals when training with simulation techniques. Our results show that all the participants considered that the activity was bene cial for their professional practice.…”

Section: Discussionmentioning

confidence: 99%

“…(12) In postgraduate neurology, it was shown that after the regular implementation of immersive simulation programs for handling stroke codes, door-to-needle times were reduced. (13) The use of mobile communication systems associated with motion tracking has been reported as a useful technology to improve coordination between professionals from pre-hospital and in-hospital systems and thus reduce stroke care time from the onset of symptoms. 14We did not nd reports in the literature of interprofessional training programs that use various simulation modalities combined; mobile communication systems associated with movement tracking technologies emulating the joint work of prehospital and hospital care levels.…”

Section: Introductionmentioning

confidence: 99%

Multimodal Simulation in Stroke: A Standardized and Virtual Patient With Mobile Tracking App for Interprofessional Training

González

Stegmeier

Millar

et al. 2020

Preprint

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Background: Ischemic stroke is a time-dependent disease, with early diagnosis and interdisciplinary and coordinated management between pre-hospital and in-hospital being key to patient management. Interprofessional training has incorporated various teaching technologies, such as simulation with standardized patients, virtual simulators, and telephone applications for tracking clinical processes. There are few publications regarding the impact of multimodal and interprofessional training on initial stroke management. The objective of this work was to evaluate the impact on confidence, perception of knowledge and satisfaction of the participants of a multimodal workshop for interprofessional training in the initial management of stroke.Methods: A workshop was organized with pre-hospital and intra-hospital interprofessional groups, based on standardized patient simulation, virtual simulation and a telephone application for tracking clinical processes. A questionnaire was applied to the 26 participants to investigate the level of satisfaction with the simulation and the telephone application. Quantitative data was analyzed using descriptive statistics.Results: The response rate was 67% (17/26). 100% reported a self-perception of increased confidence in their stroke management abilities, 100% feel that debriefing instances favor their learning and 93.4% believed that an app contributes to the improvement of prehospital management of patients.Conclusions: The use of multimodal simulation tools and technologies for process monitoring fosters the learning process and confidence of trained personnel in the initial management of time-dependent diseases such as stroke.

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“…Since 2012, we have seen how very useful it can be, both in our tertiary care stroke centre13 and within our regional stroke network 11 12. We have recently published other promising results from a one-off resident boot camp for acute stroke care in the USA, which led to a median decrease of door-to-needle time by 27% (from 79 to 58 min) 9. Another report showed that a significant shortening of door-to-groin time of about 50 min (by 70%, 73 vs 22 min) was achievable by sustained process optimisation (eg, standardised team timeout, early involvement of the neurointerventionalist and streamlining of necessary tasks) 14.…”

Section: Discussionmentioning

confidence: 99%

Tools for your stroke team: adapting crew-resource management for acute stroke care

et al. 2018

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Crew-resource management is an approach to work and training that focuses on non-technical skills and strategies to prevent human error in complex procedures. It was initially termed 'cockpit-resource management' and developed for aviation in the 1970s after several severe accidents; it has contributed to a measurable increase in flight safety. In recent years, this approach has been successfully implemented in other high-reliability environments; surgical disciplines have made particular use of crew-resource management strategies and training, with resulting reduced mortality rates. The stepwise implementation of different crew-resource management strategies in stroke care at our tertiary stroke centre has helped to speed up process times significantly, and to improve patient safety and staff satisfaction. Here, we summarise our experience in adapting different crew-resource management tools to acute stroke care, sharing specific tools that have proven valuable in our hands, and we encourage colleagues to implement such strategies in acute stroke care.

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A resident boot camp for reducing door-to-needle times at academic medical centers

Cited by 21 publications

References 21 publications

Helsinki Stroke Model Is Transferrable With “Real-World” Resources and Reduced Stroke Thrombolysis Delay to 34 min in Christchurch

Helsinki Stroke Model Is Transferrable With “Real-World” Resources and Reduced Stroke Thrombolysis Delay to 34 min in Christchurch

Multimodal Simulation in Stroke: A Standardized and Virtual Patient With Mobile Tracking App for Interprofessional Training

Tools for your stroke team: adapting crew-resource management for acute stroke care

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