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.

Transfer of Patients in a Telestroke Network: What Are the Relevant Factors for Making This Decision?

Background/Introduction: Current telestroke network consultations are focused on decision-making in the hyperacute stage of stroke management. The two main questions in telestroke consultations are whether thrombolysis should be initiated and whether the patient should be transferred to a hub hospital. Although guidelines exist for initiating intravenous thrombolytic therapy, the question of whether patients should be transferred is far more elusive. MATERIALS AND METHODS: In this study, we investigated the factors involved in the decision to transfer stroke patients to a hub hospital. We were particularly interested in identifying factors that promote or impede the transfer of patients. We enrolled 1,615 cases of telestroke consultation of the University Hospital Jena. RESULTS: The two main factors that independently influenced the probability of transferring a patient were the patient's age and the identification of a proximal vessel occlusion. Interestingly, factors such as the severity of symptoms and the time elapsed from symptom onset were not found to have an independent influence on the decision to transfer a patient. The transfer of most patients was justified by the possibility of performing interventional reperfusion therapy. DISCUSSION: We discuss the effectiveness of the current decision-making process and possible ways to improve decision-making for a more effective selection of patients who would benefit from transfer. CONCLUSION: The decision-making process to a transfer patient is not standardized and constitutes a trade-off between the intention to treat all possible patients while avoiding the transfer of patients without treatment options.