Abstract
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.
Key Words
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Article info
Publication history
Published online: April 05, 2020
Accepted:
January 25,
2020
Received in revised form:
December 27,
2019
Received:
April 19,
2019
Footnotes
The authors received support from Deutsche Forschungsgemeinschaft (DFG) for 1738 B2; BMBF Gerontosys JenAge (FKZ 031 5581B); EU BrainAge (FP 7/HEALTH.2011.2.22-2 GA No. 2798219)
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104694
Copyright
© 2020 Elsevier Inc. All rights reserved.
