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

Ferdinand O Bohmann, Natalia Kurka, Richard du Mesnil de Rochemont, Katharina Gruber, Joachim Guenther, Peter Rostek, Heike Rai, Philipp Zickler, Michael Ertl, Ansgar Berlis, Sven Poli, Annerose Mengel, Peter Ringleb, Simon Nagel, Johannes Pfaff, Frank A Wollenweber, Lars Kellert, Moriz Herzberg, Luzie Koehler, Karl Georg Haeusler, Anna Alegiani, Charlotte Schubert, Caspar Brekenfeld, Christopher E J Doppler, Oezguer A Onur, Christoph Kabbasch, Tanja Manser, Waltraud Pfeilschifter, STREAM Trial Investigators, Mohammad Alotaibi, AbdulAziz Batarfi, Annemarie Brandhofe, Roxane-Isabelle Kestner, Jan Hendrik Schaefer, Martin Alexander Schaller, Alexander Seiler, Stephanie Wallenwein, Laurent M Willems, Helmuth Steinmetz, Elke Hattingen, Zeljko Kos, Markus Naumann, Corinna Blum, Paula Bombach, Julia Zeller, Christoph Gumbinger, Jens Regula, Solveig Horstmann, Miriam Heyse, Eva Dorozewski, Christian Hamentner, Reiff Tilman, Simon Schieber, Sibu Mundiyanapurath, Silvia Schönenberger, Yahia Mokli, Markus Möhlenbruch, Jan Bewersdorf, Maximilian Einhäupl, Katharina Feil, Matthias Klein, Ken Möhwald, Konstanze Mühlbauer, Mathias Mulazzani, Guido Rohrer, Sonja Schönecker, Franziska Dorn, Philipp Mennemeyer, Torleif Sandner, Brigitte Huber, Julia Hill, Jela Gavran, Heinrich Audebert, Rohat Geran, Johannes Schurig, Juliane Herm, Felix Kleefeld, Karl Schoknecht, Denes Jadranka, Kirsten Brade, Tatjana Wittenberg, Ulrich Mayer-Runge, Maxim Bester, Michael H Schönfeld, Fabian Flottmann, Lisa Prilop, Hannes Leischner, Andreas Maximilian Frölich, Sabine Roesner, Gabriel Broocks, Uta Hanning, Stephanie Guder, Matthias Bechstein, Caspar Brekenfeld, Carmen Lange, Sebastian Kautz, Focko L Higgen, Anna Kyselyova, Götz Thomalla, Jens Fiehler, Gereon Rudolf Fink, Anna Bonkhoff, Julian Dronse, Katharina Kirsch, Sarah Laurent, Boris von Reutern, Jurij Rosen, Lukas Volz, Jan-Michael Werner, Michael Wollring, Robert Seliger, Abdulkadir Yildirim, Marc Schlamann, Jan Borggrefe, Ferdinand O Bohmann, Natalia Kurka, Richard du Mesnil de Rochemont, Katharina Gruber, Joachim Guenther, Peter Rostek, Heike Rai, Philipp Zickler, Michael Ertl, Ansgar Berlis, Sven Poli, Annerose Mengel, Peter Ringleb, Simon Nagel, Johannes Pfaff, Frank A Wollenweber, Lars Kellert, Moriz Herzberg, Luzie Koehler, Karl Georg Haeusler, Anna Alegiani, Charlotte Schubert, Caspar Brekenfeld, Christopher E J Doppler, Oezguer A Onur, Christoph Kabbasch, Tanja Manser, Waltraud Pfeilschifter, STREAM Trial Investigators, Mohammad Alotaibi, AbdulAziz Batarfi, Annemarie Brandhofe, Roxane-Isabelle Kestner, Jan Hendrik Schaefer, Martin Alexander Schaller, Alexander Seiler, Stephanie Wallenwein, Laurent M Willems, Helmuth Steinmetz, Elke Hattingen, Zeljko Kos, Markus Naumann, Corinna Blum, Paula Bombach, Julia Zeller, Christoph Gumbinger, Jens Regula, Solveig Horstmann, Miriam Heyse, Eva Dorozewski, Christian Hamentner, Reiff Tilman, Simon Schieber, Sibu Mundiyanapurath, Silvia Schönenberger, Yahia Mokli, Markus Möhlenbruch, Jan Bewersdorf, Maximilian Einhäupl, Katharina Feil, Matthias Klein, Ken Möhwald, Konstanze Mühlbauer, Mathias Mulazzani, Guido Rohrer, Sonja Schönecker, Franziska Dorn, Philipp Mennemeyer, Torleif Sandner, Brigitte Huber, Julia Hill, Jela Gavran, Heinrich Audebert, Rohat Geran, Johannes Schurig, Juliane Herm, Felix Kleefeld, Karl Schoknecht, Denes Jadranka, Kirsten Brade, Tatjana Wittenberg, Ulrich Mayer-Runge, Maxim Bester, Michael H Schönfeld, Fabian Flottmann, Lisa Prilop, Hannes Leischner, Andreas Maximilian Frölich, Sabine Roesner, Gabriel Broocks, Uta Hanning, Stephanie Guder, Matthias Bechstein, Caspar Brekenfeld, Carmen Lange, Sebastian Kautz, Focko L Higgen, Anna Kyselyova, Götz Thomalla, Jens Fiehler, Gereon Rudolf Fink, Anna Bonkhoff, Julian Dronse, Katharina Kirsch, Sarah Laurent, Boris von Reutern, Jurij Rosen, Lukas Volz, Jan-Michael Werner, Michael Wollring, Robert Seliger, Abdulkadir Yildirim, Marc Schlamann, Jan Borggrefe

Abstract

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://ichgcp.net/clinical-trials-registry/NCT03228251.

Keywords: CRM; emergency care; simulation training; stroke; thrombolysis (tPA).

Copyright © 2019 Bohmann, Kurka, du Mesnil de Rochemont, Gruber, Guenther, Rostek, Rai, Zickler, Ertl, Berlis, Poli, Mengel, Ringleb, Nagel, Pfaff, Wollenweber, Kellert, Herzberg, Koehler, Haeusler, Alegiani, Schubert, Brekenfeld, Doppler, Onur, Kabbasch, Manser, Pfeilschifter and STREAM Trial Investigators.

Figures

Figure 1
Figure 1
Timeline of the STREAM trial.

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Source: PubMed

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