Research Article| Volume 29, ISSUE 6, 104694, June 2020

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Knowledge, Motivation and Sustainability: Divergent Effects of a Staff Training Program on Residents and Specialists in Acute Stroke Care


      Background: To improve the clinical efficiency of acute stroke management, we implemented a new staff training intervention. The training consisted of a case-based discussion of recent thrombolysis cases with the entire neurologic staff for 1 year. Here, we sought to determine whether the effects of this training were sustained after the discontinuation of the intervention. Methods: All thrombolysis cases prior to the intervention (2015, 2016), during the time of training (2017) and after the discontinuation of the training (2018) were recorded and compared. The primary outcome parameter was door-to-needle time. Results: Door-to-needle time decreased from 37 minutes in the preintervention period to 28 minutes during the intervention period (P < .001). After the discontinuation of training, there was a nonsignificant trend toward an increase in door-to-needle time (31 minutes). Performance remained unchanged for residents (<6 years of neurologic training; 30.8-31.2 minutes), while the performance of specialists (>6 years of neurologic training) significantly decreased (from 25.4 minutes during the intervention to 31.7 minutes after discontinuation, P = .047). By using regression analysis to control for multiple confounding factors, we found a significant association between the intervention and an improved patient outcome (P = .008). Conclusions: The present results demonstrate improved treatment of stroke patients by a regular case-based discussion of recent thrombolysis cases. After discontinuation, the effects were sustained for the residents but not for the specialists. The results suggest that improved knowledge in residents is the main reason for better performance, while the performance of specialists was more affected by motivation.

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