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

Willems, Laurent M.; Kurka, Natalia; Bohmann, Ferdinand; Rostek, Peter; Pfeilschifter, Waltraud

doi:10.1136/practneurol-2018-001966

Cited by 12 publications

(7 citation statements)

References 13 publications

(14 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These hallmark pathologies are hypothesized to induce and amplify inflammation and vascular abnormalities, drive synaptic and neuronal loss, and eventually lead to clinical AD-dementia ( Choi et al, 2014 ; Ontiveros-Torres et al, 2016 ). The preclinical phase of AD-related pathological buildup is an insidious process which can take up to 20 years ( Perrin et al, 2009 ; Bateman et al, 2012 ; Dubois et al, 2015 ; Bilgel et al, 2016 ; De Strooper and Karran, 2016 ; Dubois, 2018 ; Douglas and Scharre, 2019 ). Intervention during this preclinical stage, before definitive clinical symptoms appear and when synaptic and neuronal damage is still limited, should hold promise for increased therapeutic efficacy.…”

Section: Introductionmentioning

confidence: 99%

Alzheimer’s Retinopathy: Seeing Disease in the Eyes

et al. 2020

View full text Add to dashboard Cite

The neurosensory retina emerges as a prominent site of Alzheimer's disease (AD) pathology. As a CNS extension of the brain, the neuro retina is easily accessible for noninvasive, high-resolution imaging. Studies have shown that along with cognitive decline, patients with mild cognitive impairment (MCI) and AD often suffer from visual impairments, abnormal electroretinogram patterns, and circadian rhythm disturbances that can, at least in part, be attributed to retinal damage. Over a decade ago, our group identified the main pathological hallmark of AD, amyloid β-protein (Aβ) plaques, in the retina of patients including early-stage clinical cases. Subsequent histological, biochemical and in vivo retinal imaging studies in animal models and in humans corroborated these findings and further revealed other signs of AD neuropathology in the retina. Among these signs, hyperphosphorylated tau, neuronal degeneration, retinal thinning, vascular abnormalities and gliosis were documented. Further, linear correlations between the severity of retinal and brain Aβ concentrations and plaque pathology were described. More recently, extensive retinal pericyte loss along with vascular platelet-derived growth factor receptor-β deficiency were discovered in postmortem retinas of MCI and AD patients. This progressive loss was closely associated with increased retinal vascular amyloidosis and predicted cerebral amyloid angiopathy scores. These studies brought excitement to the field of retinal exploration in AD. Indeed, many questions still remain open, such as queries related to the temporal progression of AD-related pathology in the retina compared to the brain, the relations between retinal and cerebral changes and whether retinal signs can predict cognitive decline. The extent to which AD affects the retina, including the susceptibility of certain topographical regions and cell types, is currently under intense investigation. Advances in retinal amyloid imaging, hyperspectral imaging, optical coherence tomography, and OCT-angiography encourage the use of such modalities to achieve more accurate, patient-and user-friendly, noninvasive detection and monitoring of AD. In this review, we summarize the current status in the field while addressing the many unknowns regarding Alzheimer's retinopathy.

show abstract

Section: Introductionmentioning

confidence: 99%

Alzheimer’s Retinopathy: Seeing Disease in the Eyes

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Previously, the trial sponsor (University Hospital Frankfurt, Germany) designed a stroke team training for the interdisciplinary multiprofessional team of its neurocenter using an in situ simulation along the entire chain of acute stroke care from the paramedics' handover to the beginning of the neurovascular intervention. We introduced the principles of CRM into our stroke care protocol with a focus on communication skills, a defined team, a binding algorithm involving the specific division of tasks and predefined “check points” for a brief team time-out (15). In order to acquaint the staff with the algorithm, we implemented monthly simulation training with a high-fidelity manikin.…”

Section: Introductionmentioning

confidence: 99%

Simulation-Based Training of the Rapid Evaluation and Management of Acute Stroke (STREAM)—A Prospective Single-Arm Multicenter Trial

et al. 2019

Self Cite

View full text Add to dashboard Cite

Introduction: Acute stroke care delivered by interdisciplinary teams is time-sensitive. Simulation-based team training is a promising tool to improve team performance in medical operations. It has the potential to improve process times, team communication, patient safety, and staff satisfaction. We aim to assess whether a multi-level approach consisting of a stringent workflow revision based on peer-to-peer review and 2–3 one-day in situ simulation trainings can improve acute stroke care processing times in high volume neurocenters within a 6 months period.Methods and Analysis: The trial is being carried out in a pre-test-post-test design at 7 tertiary care university hospital neurocenters in Germany. The intervention is directed at the interdisciplinary multiprofessional stroke teams. Before and after the intervention, process times of all direct-to-center stroke patients receiving IV thrombolysis (IVT) and/or endovascular therapy (EVT) will be recorded. The primary outcome measure will be the “door-to-needle” time of all consecutive stroke patients directly admitted to the neurocenters who receive IVT. Secondary outcome measures will be intervention-related process times of the fraction of patients undergoing EVT and effects on team communication, perceived patient safety, and staff satisfaction via a staff questionnaire.Interventions: We are applying a multi-level intervention in cooperation with three “STREAM multipliers” from each center. First step is a central meeting of the multipliers at the sponsor's institution with the purposes of algorithm review in a peer-to-peer process that is recorded in a protocol and an introduction to the principles of simulation training and debriefing as well as crew resource management and team communication. Thereafter, the multipliers cooperate with the stroke team trainers from the sponsor's institution to plan and execute 2–3 one-day simulation courses in situ in the emergency department and CT room of the trial centers whereupon they receive teaching materials to perpetuate the trainings.Clinical Trial Registration: STREAM is a registered trial at https://clinicaltrials.gov/ct2/show/NCT03228251.

show abstract

“…[14][15][16] In a recent article regarding simulation training in acute stroke, human factors in the stroke team is suggested as the most important rate-limiting factor in acute stroke care. 17 Simulation training directed at improving healthcare systems and patient care, so-called translational simulation, is particularly useful as part of quality improvement (QI) projects because of its potential both for diagnosing system performance and delivering simulation-based interventions. 18 We thus hypothesised that sessions of simulation-based team training, as part of a QI project, could reduce DNT through the following mechanisms: (1) simulation-based interventions targeted at teaching the revised treatment protocol could ease the process of implementation (eg, adherence to the revised protocol) and (2) improvements in specific team non-technical skills could lead to more efficient teams providing further reductions in DNT.…”

Section: Introductionmentioning

confidence: 99%

Reducing door-to-needle times in stroke thrombolysis to 13 min through protocol revision and simulation training: a quality improvement project in a Norwegian stroke centre

et al. 2019

View full text Add to dashboard Cite

BackgroundIn eligible patients with acute ischaemic stroke, rapid revascularisation is crucial for good outcome. At our treatment centre, we had achieved and sustained a median door-to-needle time of under 30 min. We hypothesised that further improvement could be achieved through implementing a revised treatment protocol and in situ simulation-based team training sessions. This report describes a quality improvement project aiming to reduce door-to-needle times in stroke thrombolysis.MethodsAll members of the acute stroke treatment team were surveyed to tailor the interventions to local conditions. Through a review of responses and available literature, the improvement team suggested changes to streamline the protocol and designed in situ simulation-based team training sessions. Implementation of interventions started in February 2017. We completed 14 simulation sessions from February to June 2017 and an additional 12 sessions from November 2017 to March 2018. Applying Kirkpatrick’s four-level training evaluation model, participant reactions, clinical behaviour and patient outcomes were measured. Statistical process control charts were used to demonstrate changes in treatment times and patient outcomes.ResultsA total of 650 consecutive patients, including a 3-year baseline, treated with intravenous thrombolysis were assessed. Median door to needle times were significantly reduced from 27 to 13 min and remained consistent after 13 months. Risk-adjusted cumulative sum charts indicate a reduced proportion of patients deceased or bedridden after 90 days. There was no significant change in balancing measures (stroke mimics, fatal intracranial haemorrhage and prehospital times).ConclusionsImplementing a revised treatment protocol in combination with in situ simulation-based team training sessions for stroke thrombolysis was followed by a considerable reduction in door-to-needle times and improved patient outcomes. Additional work is needed to assess sustainability and generalisability of the interventions.

show abstract

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

Cited by 12 publications

References 13 publications

Alzheimer’s Retinopathy: Seeing Disease in the Eyes

Alzheimer’s Retinopathy: Seeing Disease in the Eyes

Simulation-Based Training of the Rapid Evaluation and Management of Acute Stroke (STREAM)—A Prospective Single-Arm Multicenter Trial

Reducing door-to-needle times in stroke thrombolysis to 13 min through protocol revision and simulation training: a quality improvement project in a Norwegian stroke centre

Contact Info

Product

Resources

About