A translational simulation and protocol for inpatient stroke in Mallow General Hospital

Abstract Background Stroke is a medical emergency where time is crucial to preserve neurological function. We organised a simulation training for doctors in Mallow General Hospital to improve knowledge, skills and confidence in managing acute strokes as inpatient. We used translational simulation which aims to improve patient outcomes through identifying safety and performance issues and delivering interventions. We also developed a protocol for inpatient stroke which we discussed as a medical team. Mallow General Hospital is a model 2 hospital which has 76 inpatient beds and has an acute medical unit, which accepts patients via GP referral and discussion with ambulance staff. As strokes do not present acutely to Mallow Hospital, there was limited experience managing strokes in this setting. Methods We discussed and got feedback on a potential stroke protocol with radiology and pharmacy. After this, we organised a simulation session where the clinical director, the consultant body and non-consultant doctors were present. This involved the recognition, assessment, investigation and management of stroke. There was an opportunity for discussion, including particular issues that might be presented in and out of hours and how best to resolve them. Afterwards, we introduced a stroke protocol which we had devised. It included availability of imaging in and out of hours, availability of thrombolysis and how to give it, and escalation pathways. Results Participants were given the opportunity to develop and get feedback in a safe environment. It was also an opportunity for staff to share their knowledge and concerns. The feedback was subsequently used to adapt our inpatient stroke protocol. This protocol is now available and has been used in the clinical setting. Conclusion If a clinical scenario is uncommon in your institution, simulation is an opportunity to safely improve staff knowledge and skills, as well as identifying potential harms and delays to patient care.