Simulation-Based Quality Improvement and Training to Improve Door to Puncture Time for Mechanical Thrombectomy.

Abstract

Introduction: Mechanical Thrombectomy (MT) exists as the gold standard for the management of acute ischaemic stroke secondary to large vessel occlusion. There is a direct correlation between reduced time to reperfusion and improved patient outcomes. Our study aimed to optimise processes and reduce the time from the patient's arrival at hospital to vascular puncture for MT (DTP time) through simulation-based quality improvement and staff training.

Methods: This single-centre prospective study involved two simulation exercises completed over 3 months from March to May 2023. The multidisciplinary simulations involved staff following the MT patient's hyperacute journey from the time of arrival to the Emergency Department triage. Data from all patients at our centre who underwent MT in the 6-month period pre- and post-simulation training were included. The primary outcome measured was the DTP time. For statistical analysis, a paired t-test was used to compare values.

Results: In the period prior to the simulation exercises, our hospital recorded 19 direct-to-hospital presentations for patients requiring MT, where we recorded a mean DTP time of 132.38 min. Post the simulation training, we recorded 26 direct-to-hospital presentations, with a mean DTP time of 104.52 min (a reduction of 27.86 min, p = 0.02). Our study did not find any statistically significant difference in DTP time for patients who were inter-hospital transfer presentations.

Conclusions: We validated simulation-based training as an effective intervention for reducing time to reperfusion for patients undergoing MT. Implementation of regular training for staff can improve patient outcomes.