TACKLING THROMBO-LYSO-PHOBIA: USING SIMULATION TO IMPROVE CONFIDENCE IN STROKE THROMBOLYSIS IN GENERAL INTERNAL MEDICAL REGISTRARS

ABSTRACT

Background: In the South-West, the majority of out-of-hours stroke thrombolysis calls are lead by the general internal medical (GIM) registrars, not neurology/stroke specialists. There are local variations in the availability of senior and nursing stroke support to support these decisions and significant colloquial fear of carrying out stroke thrombolysis affecting medical registrar confidence and willingness to thrombolyse. This in turn may affect the door-to-needle (DTN) time and patient outcomes. Method: Following positive feedback from a successful IMT3 stroke simulation scenario, a three-scenario course was devised and lead by the neurology team at Derriford and, supported by deanery funding was rolled out to include the entire deanery. Scenarios included thrombolysis, thrombectomy and hypertension control. Results: Feedback from participants identified key pre-course questions and confidence, and usefulness of each scenario and overall confidence post-course. Feedback showed a progressive improvement in each participants confidence in carrying out stroke thrombolysis and there was positive written comments. 100% of participants would recommend this training to a friend. There has been yet to show a clear improvement in door-to-needle time however this is likely compounded by the current pressures facing the NHS with COVID-19 pressures and over-crowding. Conclusion: Stroke simulation has improved participants confidence at carrying out stroke thrombolysis out-of-hours for the GIM registrar. The authors feel that it should be included routinely in the induction and continued education of the general internal medical registrar and there is much potential to spread out to the MDT assessing stroke thrombolysis. Scenarios and learning points available on https//www.plymouthhospitals. nhs.uk/stroke.