International Journal of Healthcare Simulation

Background:

Stroke remains the second leading cause of death worldwide and an important diagnosis requiring early recognition and action for optimal clinical outcomes which are time dependent ^[1]. With heterogeneity in healthcare systems according to trust and resources, it is key that healthcare workers are aware of the local pathways for time-critical conditions such as stroke. Delayed recognition and management of an inpatient stroke prompted the development of an acute neurology simulation course at a London district general hospital aimed at junior doctors.

Aims:

The aim of the course was to inform about the local stroke pathways, ensure juniors are comfortable with recognition of stroke and to develop the non-technical skills required in stroke management, thus enabling skill acquisition in a safe environment.

Method:

An innovative course was created using SimMan 3G with a focus on ensuring high fidelity to overcome the limitations associated with the practical aspect of stroke assessment in a mannequin. Five scenarios were created to last 15 minutes: three of which involved acute stroke diagnosis and two about stroke ‘mimics’. These scenarios included the involvement of a junior doctor, an acting nurse and acting members of the multi-disciplinary team as required. The debrief following each scenario would cover the technical aspects of management and self and group reflections. To add to the fidelity when assessing a mannequin for neurological conditions, we ensured that slurred speech could be mimicked, weakness in the limbs was showcased and facial asymmetry represented with innovative techniques using the mannequin.

Results:

Two sessions have been delivered involving nine junior doctors and this has been implemented as a regular course for junior doctors and nurses. All attendees felt more confident with stroke recognition, awareness of stroke mimics and of the local pathways when managing patients with acute stroke.

Implications for practice:

The positive feedback received and the outcome that all attendees felt more confident following the course suggest that stroke recognition and management can be learnt using simulation with a focus on the human factors required to optimize patient care. We hope to continue delivering this course to junior doctors rotating through the hospital and hope to open it up to the wider multi-disciplinary team including nursing staff, healthcare assistants and therapists with a focus on recognition and escalation. Dissemination of learning on local pathways and management using simulation is effective and can impact patient care.