Abstract WMP85: Simulation Training Improves Door-to-Needle Time for Intravenous Thrombolysis

Abstract

Background: Clinical need exists to shorten door-to-needle time (DNT) for intravenous thrombolysis but effective training methods are missing. Simulation training improves teamwork and logistics in numerous fields but it is not clear if simulation improves logistics in stroke. Methodology This is a nation-wide study to evaluate efficacy of simulation training conducted between 2016-2018 and measured by DNT in centers participating in simulation training program as compared to the rest of stroke centers in the Czech Republic. Information about DNT was obtained from prospectively collected data from nationally used Safe Implementation Treatment in Stroke Registry (SITS). Outcome is improvement in DNT in 2018 as compared to 2015 (after and before the simulation training period). Scenarios are based on real clinical cases and are initiated by pre-notification from EMS through indication of thrombolysis and ends by indication for mechanical thrombectomy. Simulation courses were conducted in standardly equipped simulation center (hospital bed, stretcher, simulation monitor, artificial CT scanner, audiovisual equipment etc.). Results: Between 2016 and 2018, 10 courses were conducted for stroke teams from 9 of all 45-stroke centers in the Czech Republic. DNT was available both in 2015 and 2018 in 41 (91%) of 45 stroke centers. Stroke centers that passed simulation training improved their DNT in 2018 as compared to 2015 by 30 minutes (95%CI 25.7-34.7) as compared to 20 minutes (95%CI 15.8-24.3) in stroke centers that did not pass the simulation training (p=0.01). Conclusion: DNT considerably shortened in all stroke centers and simulation training additionally improved door-to-needle time by 10 minutes. Simulation training is useful training method to improve logistics in stroke.