Implementation of an in-hospital stroke simulation protocol

Abstract

Purpose A major component of hospital stroke care involves prompt identification of stroke in admitted patients. Delays in recognizing stroke symptoms and initiating treatment for in-hospital stroke can adversely impact patient outcomes. This quality improvement intervention used simulation together with a traditional lecture to instruct nurses at a university hospital about a new stroke protocol being implemented to increase rapid recognition of stroke and meet Joint Commission National Hospital Inpatient Quality Measures. The paper aims to discuss these issues. Design/methodology/approach In total, 86 registered nurses from the neurology and cardiology units attended a lecture and participated in a simulation scenario with a standardized patient exhibiting stroke symptoms. Participants completed a ten-item pre-test to measure their knowledge of stroke care prior to the lecture; they repeated the test pre-simulation and once again post-simulation to evaluate changes in knowledge. Findings Overall mean stroke knowledge scores increased significantly from pre-lecture to pre-simulation, and from pre-simulation to post-simulation. Simulation plus lecture was more effective than lecture alone in increasing knowledge about hospital stroke protocol despite assigned unit (cardiology or neurology), years of experience, or previous exposure to simulation. Research limitations/implications All eligible nurses who agreed to participate received training, making it impossible to compare improvements in knowledge to those who did not receive the training. Originality/value A diverse array of nursing professionals and their patients may benefit from simulation training. This quality improvement intervention provides a feasible model for establishing new care protocols in a hospital setting.

Identifying Best Practices to Improve Evaluation and Management of In-Hospital Stroke: A Scientific Statement From the American Heart Association

“…This is an area in which improved education with a variety of tools such as simulation laboratories might improve recognition and diagnosis. 51…”

“…This is an area in which improved education with a variety of tools such as simulation laboratories might improve recognition and diagnosis. 51 Nurses are often the first hospital staff to recognize a patient with symptoms that might indicate in-hospital stroke and activate a stroke alert. Nurses activate inhospital stroke alerts significantly earlier than physicians or advanced practice clinicians (median, 2.0 hours versus 4.9 hours) from last known well time, with median nursing activation time falling within a 3-hour window for potential systemic thrombolytic or early endovascular therapy.…”

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

“…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.…”

Nursing and Institutional Responsibilities for In-Hospital Stroke

“…In terms of education and training, simulation-based learning using standardized patients may improve nurses' ability to identify stroke symptoms. 33 A study by Mellon et al 34 found that while some staff could identify symptoms of stroke, they were unaware of treatment windows for thrombolytic therapy. This knowledge gap emphasizes the need for staff education focused on both symptom recognition and appropriate treatment protocols.…”