AUTHOR=Bohmann Ferdinand O. , Kurka Natalia , du Mesnil de Rochemont Richard , Gruber Katharina , Guenther Joachim , Rostek Peter , Rai Heike , Zickler Philipp , Ertl Michael , Berlis Ansgar , Poli Sven , Mengel Annerose , Ringleb Peter , Nagel Simon , Pfaff Johannes , Wollenweber Frank A. , Kellert Lars , Herzberg Moriz , Koehler Luzie , Haeusler Karl Georg , Alegiani Anna , Schubert Charlotte , Brekenfeld Caspar , Doppler Christopher E. J. , Onur Oezguer A. , Kabbasch Christoph , Manser Tanja , Pfeilschifter Waltraud , STREAM Trial Investigators , Alotaibi Mohammad , Batarfi AbdulAziz , Brandhofe Annemarie , Kestner Roxane-Isabelle , Hendrik Schaefer Jan , Alexander Schaller Martin , Seiler Alexander , Wallenwein Stephanie , M. Willems Laurent , Steinmetz Helmuth , Hattingen Elke , Kos Zeljko , Naumann Markus , Blum Corinna , Bombach Paula , Zeller Julia , Gumbinger Christoph , Regula Jens , Horstmann Solveig , Heyse Miriam , Dorozewski Eva , Hamentner Christian , Tilman Reiff , Schieber Simon , Mundiyanapurath Sibu , Schönenberger Silvia , Mokli Yahia , Möhlenbruch Markus , Bewersdorf Jan , Einhäupl Maximilian , Feil Katharina , Klein Matthias , Möhwald Ken , Mühlbauer Konstanze , Mulazzani Mathias , Rohrer Guido , Schönecker Sonja , Dorn Franziska , Mennemeyer Philipp , Sandner Torleif , Huber Brigitte , Hill Julia , Gavran Jela , Audebert Heinrich , Geran Rohat , Schurig Johannes , Herm Juliane , Kleefeld Felix , Schoknecht Karl , Jadranka Denes , Brade Kirsten , Wittenberg Tatjana , Mayer-Runge Ulrich , Bester Maxim , Schönfeld Michael H , Flottmann Fabian , Prilop Lisa , Leischner Hannes , Maximilian Frölich Andreas , Roesner Sabine , Broocks Gabriel , Hanning Uta , Guder Stephanie , Bechstein Matthias , Brekenfeld Caspar , Lange Carmen , Kautz Sebastian , Higgen Focko L. , Kyselyova Anna , Thomalla Götz , Fiehler Jens , Rudolf Fink Gereon , Bonkhoff Anna , Dronse Julian , Kirsch Katharina , Laurent Sarah , von Reutern Boris , Rosen Jurij , Volz Lukas , Werner Jan-Michael , Wollring Michael , Seliger Robert , Yildirim Abdulkadir , Schlamann Marc , Borggrefe Jan
TITLE=Simulation-Based Training of the Rapid Evaluation and Management of Acute Stroke (STREAM)—A Prospective Single-Arm Multicenter Trial
JOURNAL=Frontiers in Neurology
VOLUME=10
YEAR=2019
URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2019.00969
DOI=10.3389/fneur.2019.00969
ISSN=1664-2295
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://clinicaltrials.gov/ct2/show/NCT03228251.