Simulation-based training of the rapid evaluation and management of acute stroke (stream)—a prospective single-arm multicenter trial

  • 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

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Author:Ferdinand Bohmann, Natalia Kurka, Richard Klaus Frieder 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 Arne Wollenweber, Lars Kellert, Moriz Herzberg, Luzie Katharina Köhler, Karl Georg Häusler, Anna Alegiani, Charlotte Schubert, Caspar Brekenfeld, Christopher Emanuel Julian Doppler, Özgür Abdullah Onur, Christoph Kabbasch, Tanja Manser, Waltraud PfeilschifterORCiDGND
Pubmed Id:
Parent Title (English):Frontiers in neurology
Publisher:Frontiers Research Foundation
Place of publication:Lausanne
Contributor(s):Gordon B. Young
Document Type:Article
Year of Completion:2019
Date of first Publication:2019/09/11
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Contributing Corporation:STREAM Trial Investigators
Release Date:2019/10/16
Tag:CRM; emergency care; simulation training; stroke; thrombolysis (tPA)
Issue:Art. 969
Page Number:9
First Page:1
Last Page:9
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. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Institutes:Medizin / Medizin
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - Namensnennung 4.0