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Stroke Code from EMS to Thrombectomy: An Interdisciplinary in Situ Simulation for Prompt Management of Acute Ischemic Stroke

Authors:

Nicola Feldman ,

Icahn School of Medicine at Mount Sinai, US
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Lorraine Boehm,

NYC Health+Hospitals/Elmhurst, US
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Magda Zavala,

NYC Health+Hospitals/Elmhurst, US
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Barbara Dilos,

Icahn School of Medicine at Mount Sinai, US
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Mamie McIndoe,

NYC Health+Hospitals/Elmhurst, US
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Latchmi Nagaswar,

NYC Health+Hospitals/Elmhurst, US
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Katie Walker,

NYC Health+Hospitals, US
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Donnie Bell,

NYC Health+Hospitals, US
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Devorah Nazarian,

Icahn School of Medicine at Mount Sinai, US
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Joseph Rabinovich,

Icahn School of Medicine at Mount Sinai, US
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Stuart Kessler,

Icahn School of Medicine at Mount Sinai, US
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Laura Iavicoli,

Icahn School of Medicine at Mount Sinai, US
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Phillip Fairweather,

Icahn School of Medicine at Mount Sinai, US
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Joseph Farraye,

Icahn School of Medicine at Mount Sinai, US
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Hazem Shoirah,

Icahn School of Medicine at Mount Sinai, US
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Suzanne Bentley

Icahn School of Medicine at Mount Sinai, US
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Abstract

Background: The treatment of acute ischemic stroke is challenging because it requires prompt management, interdisciplinary collaboration, and adherence to specific guidelines. We seek to address these challenges using simulation, which has been shown to be an effective educational technique that enhances patient outcomes, including by improving clinical team performance and allowing for systems testing.

Hypothesis/Research Question: Impromptu, in situ simulation can provide an effective teaching strategy for enhancing clinicians’ appropriate, prompt, and interdisciplinary management of acute stroke.

Methods: An in situ simulation of a stroke code was designed and conducted at unannounced times. Simulations occurred in the real clinical environment, using real hospital equipment and involving the actual on-shift clinicians who would respond. To begin the simulation, an ED team was presented with a 55-year-old simulated patient with chief complaint of speech difficulty and right-sided weakness. The team needed to assess her appropriately, including activating the Stroke Team via the live hospital paging system. The Stroke Team responded to further coordinate evaluation, obtain appropriate imaging, administer thrombolytic therapy, and recognize the need for thrombectomy. Upon simulation completion, debriefing was utilized to review the case and team performance. Additionally, latent safety threats were recorded, if present. Finally, participants completed an evaluation to gauge the simulation’s effectiveness.

Results:Debriefings demonstrated robust discussion and learner reinforcement of the importance of timeliness; critical stroke code actions; and the need for collaboration, teamwork, and communication in the management of acute stroke patients. Evaluations indicated that 100% of learners found the simulation to be an effective clinical, teamwork, and communication teaching tool, and all believed it would change their future performance on the stroke team.

Conclusions: Impromptu, in situ simulation helps develop interdisciplinary teamwork and clinical knowledge and is useful for reviewing crucial times and processes required for best-practice patient care. This is particularly valuable when timely management is essential, such as in acute ischemic stroke in this case.

How to Cite: Feldman, N., Boehm, L., Zavala, M., Dilos, B., McIndoe, M., Nagaswar, L., Walker, K., Bell, D., Nazarian, D., Rabinovich, J., Kessler, S., Iavicoli, L., Fairweather, P., Farraye, J., Shoirah, H. and Bentley, S., 2021. Stroke Code from EMS to Thrombectomy: An Interdisciplinary in Situ Simulation for Prompt Management of Acute Ischemic Stroke. ISMMS Journal of Science and Medicine, 1(2), p.9. DOI: http://doi.org/10.29024/ijsm.56
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  Published on 12 May 2021
 Accepted on 14 Apr 2021            Submitted on 14 Apr 2021

Competing Interests

The authors have no competing interests to declare.

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