Education Research: Simulation training for neurology residents on acquiring tPA consent

Rostanski, Sara; Kurzweil, Arielle; Zabar, Sondra; Balcer, Laura J.; Ishida, Koto; Galetta, Steven; Lewis, Ariane

doi:10.1212/wnl.0000000000006651

Cited by 11 publications

(5 citation statements)

References 9 publications

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“…Additionally, many studies performed local (in situ) simulation,9 20 while our simulation was done centrally in an equipped simulation centre. Finally, some studies did not measure patient-relevant outcomes, but instead measured an improvement in knowledge 19 26 27. Nevertheless, two previously published studies from Germany and Norway20 21 and our study document that simulation training contributes to a short final DNT.…”

Section: Discussionmentioning

confidence: 58%

Simulation-based team training improves door-to-needle time for intravenous thrombolysis

et al. 2023

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PurposeThere is a clinical need for shortened door-to-needle time (DNT) for intravenous thrombolysis, but effective training methods are missing. Simulation training improves teamwork and logistics in numerous fields. Still, it is not clear if simulation improves logistics in stroke.MethodsTo evaluate the efficiency of a simulation training programme, the DNT of participating centres was compared with the rest of stroke centres in the Czech Republic. Patients’ data were prospectively collected from the nationally used Safe Implementation of Treatments in Stroke Registry. The outcome was an improvement in DNT in 2018 as compared with 2015 (after and before the simulation training). Scenarios were based on real clinical cases, and simulation courses were conducted in a standardly equipped simulation centre.FindingsBetween 2016 and 2017, 10 courses were conducted for stroke teams from 9 of all 45 stroke centres. DNT data were available both in 2015 and 2018 from 41 (91%) stroke centres. The simulation training improved the DNT in 2018 as compared with 2015 by 30 min (95% CI 25.7 to 34.7) and as compared with 20 min (95% CI 15.8 to 24.3) in stroke centres without the simulation training (p=0.01). Any parenchymal haemorrhage occurred in 5.4% and 3.5% of patients treated in centres without and with simulation training (p=0.054), respectively.ConclusionsDNT was considerably shortened nationally. It was feasible to implement simulation as a nationwide training programme. The simulation was associated with improved DNT; however, other studies should confirm that such an association is causal.

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Section: Discussionmentioning

confidence: 58%

Simulation-based team training improves door-to-needle time for intravenous thrombolysis

et al. 2023

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“…Thus, physicians should get the gist across in a more skilled way in informed consent to shorten the time consuming of proxies’ decision-making. Supplying simulation training for neurology residents on acquiring tPA consent 45 might be helpful.…”

Section: Discussionmentioning

confidence: 99%

Decision-making psychological state and characteristic of proxies of thrombolytic patients: a pilot study

Guo

Liu

Guo

et al. 2022

Sci Rep

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Intravenous thrombolysis is the preferred treatment modality for acute ischemic stroke. In China, written informed consent from patients or proxies must be obtained before intravenous thrombolysis is performed, which always leads to in-hospital delay of thrombolysis. To explore the relationship between characteristics of thrombolysis decision-making and psychological states of proxies of AIS patients. This was a pilot study. 231 proxies of AIS patients were recruited, including 147 males and 84 females. STAI, WFPTS, CAOT, CPS, C-DCS and time-consuming of decision-making were collected by trained nurses during the period from signing informed consent to thrombolysis finished. The general information was collected within 24 h after admission. Pearson correlation analysis and the Ridge regression analysis were used to explore the correlation and causality between psychological indicators (STAI, WFPTS, CAOT, CPS) and decision-making characteristics (C-DCS, Time consuming). Structural equation modeling was used to explore the direct and indirect effect of psychological factors on decision-making characteristics. The mean of anxiety, trust in physicians, and decision conflict were 49.20 ± 9.50, 37.83 ± 6.63 and 30.60 ± 14.77, respectively. The CAOT was associated with C-DCS through the mediation of STAI and WFPTS (p < 0.001). The CAOT was associated with time-consuming through the mediation of STAI, WFPTS and CPS (p < 0.05). The CAOT, STAI and WFPTS were associated with C-DCS (p < 0.05), and STAI, WFPTS and CPS were associated with time-consuming (p < 0.01). The proxy of patients with acute ischemic stroke had severe decision conflict in thrombolysis decision-making. The psychological state was associated with decision conflict and the time-consuming. Medical staff should explore methods to release the anxiety and increase the trust in physicians to reduce the decision-making conflict and time-consuming, which could promote the smooth progress of the informed consent.

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“…22 Simulation coaching of trainees who are often on the front lines of patient evaluation can also improve the accuracy and effectiveness of the communication of risks and benefits of thrombolysis. 23 Visual aids and structured scripts have been shown to shorten consent times and improve understanding among families and patients during consent. [24][25][26] Future decision models such as the Stroke-Thrombolytic Predictive Instrument may personalize outcome data further to help patients and families participate in the conversation.…”

Section: Discussionmentioning

confidence: 99%

Thrombolytic Refusal Over Telestroke

et al. 2021

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IntroductionTissue plasminogen activator (tPA) refusal is 4%–6% for acute ischemic stroke (AIS) in the emergency room. Telestroke (TS) has increased the use of tPA for AIS, but is accompanied by barriers in communication that can affect tPA consent. We characterized the incidence of tPA refusal in our TS network and its associated reasons.MethodsPatients with AIS who were offered tPA within 4.5 hours from symptom onset according to American Heart Association guidelines were identified within our Lone Star Stroke Consortium Telestroke Registry from September 2015 to December 2018. We compared baseline characteristics and clinical outcomes between patients who refused tPA and patients who accepted tPA.ResultsAmong the 1242 patients who qualified for tPA and were offered treatment, 8% refused tPA. Female and non-Hispanic black patients and patients with prior history of stroke were more likely to decline tPA. Patients who refused tPA presented with a lower NIHSS and was associated with a final diagnosis of stroke mimic (odds ratio [0.23]; 95% confidence interval [CI] 0.15–0.36). Good outcome (90 days modified Rankin Scale 0–2) was the same among patients who received tPA and those who refused (OR 0.80; 95% CI 0.42–1.54). The most common reasons for refusal were rapidly improving and mild/non-disabling symptoms and concern for potential side effects.ConclusiontPA refusal over TS is comparable to previously reported rates; there was no difference in outcomes among patients who received tPA compared to those who refused. Sex and racial differences associated with an increase tPA refusal warrant further investigation in efforts to achieve equity/parity in tPA decisions.

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Education Research: Simulation training for neurology residents on acquiring tPA consent

Cited by 11 publications

References 9 publications

Simulation-based team training improves door-to-needle time for intravenous thrombolysis

Simulation-based team training improves door-to-needle time for intravenous thrombolysis

Decision-making psychological state and characteristic of proxies of thrombolytic patients: a pilot study

Thrombolytic Refusal Over Telestroke

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