Stroke simulations have a multidisciplinary nature with respiratory therapists, neurosciences PCC, simulation technicians, stroke nurses and residents, and emergency residents, nurses, educators and clinicians working together.
When a person has a stroke, a blockage or bleed in the brain, the countdown is on in a devastating way. For each minute of a stroke, an estimated 1.9 million brain cells die.
Optimal care for stroke patients depends on every minute that passes, which is why the VGH Emergency Department and Code Stroke team works to better response time through practice and simulations. The faster we are able to diagnose the stroke, the faster we are able to provide the correct treatment.
“Door-to-scan” time measures how long it takes the patient to move through admitting and triage to the CT scan so we can diagnose a treatable stoke faster. Similarly, “door-to-needle” time represents the time from entering the hospital to administering the clot busting drug tPA. Our current goals for “door-to-scan” is under 10 minutes and “door-to-needle” under 30 minutes.
To improve our response, the VGH Emergency Department educators and Stroke Team leads facilitated an innovative simulation exercise. The first “ED Stroke Activation simulation" occurred July 23, 2019 and has subsequently become a regular shared monthly exercise for these two specialized teams.
Providing optimal patient care requires continuous learning, teamwork, and the application of evidence-based protocols in accordance with the Canadian Acute Stroke Care guidelines. A key component of this specialized patient care is the “code stroke team activation" protocol, which is manifested in a variety of ways, including:
Pre-Hospital – A pre-hospital activation allows for the Code Stroke Team to arrive prior to patient arrival based on information provided by BC Ambulance or a sending facility. It gives the opportunity for pre-registration of the patient which serves to expedite diagnostics and stroke interventions.
On- arrival – Occurs at the time of patient arrival in the Emergency Department following prompt assessment and identification by the emergency triage nurse, who determines if the patient meets Code Stroke criteria and then collaborates with the Emergency Physician.
Post-arrival – The emergency nurse activates a Code Stroke for a patient who may have had an initial admission for various medical reasons, but has had a change in their neurological status, that now meets the criteria for a Code Stroke Team Activation
Practicing our team response, via simulation, to an acute stroke event fosters improved communication, team dynamics, and timeliness of care, as well as identifying any opportunities for improvement in established protocols or processes. These exercises would not be possible without the operational support of the emergency department head nurses and charge nurses, and the infrastructure provided by the VGH ED Sim Program.
Simulating how to give alteplase -- a life-saving medication for ischemic strokes.