Abstract
BackgroundStroke is a clinical priority requiring early specialist assessment and treatment. A London (UK) stroke strategy was introduced in 2010, with Hyper Acute Stroke Units (HASUs) providing specialist and high dependency care. To support increased numbers of specialist staff, innovative multisite multiprofessional simulation training under a standard protocol-based curriculum took place across London.This paper reports on an independent evaluation of the HASU training programme. The main aim was to evaluate mechanisms for behaviour change within the training design and delivery, and impact upon learners including potential transferability to the clinical environment.MethodsThe evaluation utilised the Behaviour Change Wheel framework. Procedures included: mapping training via the framework; examination of course material; direct and video-recorded observations of courses; pre-post course survey sheet; and follow up in-depth interviews with candidates and faculty.ResultsPatient management skills and trainee confidence were reportedly increased post-course (post-course median 6 [IQ range 5–6.33]; pre-course median 5 [IQ range 4.67–5.83]; z = 6.42, P < .001). Thematic analysis showed that facilitated ‘debrief’ was the key agent in supporting both clinical and non-clinical skills. Follow up interviews in practice showed some sustained effects such as enthusiasm for role, and a focus on situational awareness, prioritization and verbalising thoughts. Challenges in standardising a multi-centre course included provision for local context/identity.ConclusionsPan-London simulation training under the London Stroke Model had positive outcomes in terms of self-reported skills and motivation. These effects persisted to an extent in practice, where staff could recount applications of learning. The evaluation demonstrated that a multiple centre simulation programme congruent with clinical practice can provide valuable standard training opportunities that support patient care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-015-0423-1) contains supplementary material, which is available to authorized users.
Highlights
Stroke is a clinical priority requiring early specialist assessment and treatment
The London stroke strategy In 2008, a London-specific stroke strategy was published that made a number of recommendations, including implementation of a new model of acute care incorporating eight hyper-acute stroke units (HASUs) that would
This paper reported on a structured evaluation of a multi-centre simulation training programme for hyper acute stroke medicine
Summary
A London (UK) stroke strategy was introduced in 2010, with Hyper Acute Stroke Units (HASUs) providing specialist and high dependency care. The stroke care model was co-created through a series of events with key stakeholders, clinical experts, patients and carers as well as representatives from carer groups. Subsequent to this wide engagement, the new model was introduced in 2010 with each HASU providing: immediate response; specialist assessment on arrival; brain imaging and thrombolysis (if appropriate) within 30 min; high dependency care and stabilisation. The patient is transferred to a stroke unit for rehabilitation and discharge to community care
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