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S Koushik, S Nagsayi, L Coombe, C Aguirre, M Elfeky, 2829 Improving door to needle times in stroke thrombolysis through simulation-based training in a district general hospital, Age and Ageing, Volume 54, Issue Supplement_1, January 2025, afae277.030, https://doi.org/10.1093/ageing/afae277.030
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Abstract
Teamwork is very important in hospitals where the medical on-call team manage the stroke and thrombolysis alert calls. In addition to technical skills, human factors play a very significant role in meeting a target door-to-needle time.
To improve door-to-needle time by improving human factors (leadership, understanding and delegation of roles and confidence in participation) and technical factors (quick NIHSS and efficient documentation of vital information on radiology request forms for urgent CT head).
We conducted 6 simulation-based training sessions and de-briefing sessions (role-playing and education around technical and non-technical skills) starting from November 2022. We measured the participants’ responses before and after the sessions, with the help of Kirkpatrick’s four level training evaluation model. We measured and compared the thrombolysis breakdown data (total of 38 consecutive patients from May 2022 to February 2023) throughout the process. We used statistical process control (SPC) charts to calculate and visually represent median values to demonstrate the changes.
Thrombolysis breakdown data revealed substantial improvement post intervention (November 2022) compared to data from May–October 2022. SPC charts demonstrated significant reduction and step change in median door-to-needle time (83.7 to 52.2 minutes) and CT imaging to reporting time (36.2 min to 19.5 min).
A series of simulation-based training sessions and debriefing sessions for stroke thrombolysis was able to demonstrate statistically significant improvement in door-to-needle time. We will continue the simulation sessions and will assess sustainability of the interventions.
Declaration of Funding
None.
1. Ajmi SC, Advani R, Fjetland L. et al. 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. BMJ Quality & Safety. 2019;28:939–48.
2. Chalwin RP, Flabouris A. Non-technical skills training for MET. Intern Med J. 2013;43:962–9. https://doi.org/10.1111/imj.12172.
- thrombolytic therapy
- diagnostic radiologic examination
- cerebrovascular accident
- ischemic stroke
- safety
- diagnostic imaging
- radiology specialty
- role playing therapy
- role playing disorder
- skills training
- head ct
- quality improvement
- nih stroke scale
- simulation training
- door to needle time
- human factors engineering
- statistical process control
- stroke center
- work teams
- norwegian
- debriefing
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