Stroke simulation leads to quicker treatment time

A 49-year-old female is led by a family member into the St. Mary’s Hospital Emergency department. Her speech is slurred, one side of her face is paralyzed and she is experiencing blurred vision—all telltale signs of a stroke.

The scene is not a real emergency, but instead a simulation exercise put on by staff at St. Mary’s Emergency department in Camrose. The scene may be staged, but the lessons learned are very real and will help improve the unit’s response time for the next stroke patient who comes through the ER doors.

“This is the first time we are doing the simulation,” says Michelle Bowman, Emergency Room Manager. “We’re doing it primarily to identify barriers that would reduce the time it takes to treat the stroke patient.”

The simulation was done in partnership with Alberta Health Services (AHS) and its eSIM provincial simulation team. The main goal of the exercise is to reduce the "door-to-needle" time from when a patient enters the hospital doors to when they receive thrombolytic medication by needle.

Michelle says once a patient shows up in the hospital with stroke symptoms, they are assessed and a CT scan is ordered to reveal whether the patient’s stroke is caused by a blood clot or bleeding. If it’s caused by a clot, the medical team will administer a thrombolytic drug by needle to reverse or minimize the debilitating effects caused by stroke.

“The goal in Alberta to receive medication [thrombolytic drug] right now is 60 minutes,” says Michelle. “The Quality Improvement and Clinical Research Alberta Stroke program wants our goal to be 30 minutes across Alberta.” 

Part of the team to decide on treatment includes a stroke neurologist, typically based in Edmonton at the University of Alberta Hospital. In today’s simulation, the medical team connect via teleconference to Dr. Siddiqi, a stroke neurologist. 

St. Mary’s Registered Nurse Kierstin Burnstad consults with Stroke Neurologist Dr. Siddiqi on a teleconference call to help assess patients.

Today’s simulation was the second of the day—the first was completed in 37 minutes. “Today is all about co-ordinating the simulation to make us more efficient,” says Michelle. “It’s a co-ordination of nurses, CT staff, the lab staff, the ER doctor and the stroke neurologist on telehealth.”

“We believe if we give a team a realistic scenario in their environment, the skills and knowledge and the team dynamics that they practise in simulation will transfer into clinical practice,” says Nadine Terpstra, Registered Nurse and Simulation Consultant, AHS. 

Lab Technician Brittany Woelk prepares pretend patient Nadine Terpstra for a CT scan to determine what kind of clot is causing Nadine’s stroke symptoms.

“Simulation allows participants to practise in a safe, controlled, risk-free environment without causing harm to someone’s loved one. It’s all about the patient getting safe, effective care,” says Nadine.

In 2014, St. Mary’s Hospital received 61 stroke patients, 16 of whom qualified to receive the medication. In 2015, from January to October, 14 stroke patients received this thrombolytic drug.

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