Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany.
Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany; Biomagnetic Center, Jena University Hospital, Jena, Germany.
J Stroke Cerebrovasc Dis. 2020 Jun;29(6):104694. doi: 10.1016/j.jstrokecerebrovasdis.2020.104694. Epub 2020 Apr 5.
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.
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.
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).
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.
为了提高急性脑卒中管理的临床效率，我们实施了一项新的员工培训干预措施。培训包括对过去 1 年中所有溶栓病例进行基于案例的讨论，涉及整个神经科工作人员。在这里，我们试图确定在干预措施停止后，这种培训的效果是否持续。
记录并比较了干预前（2015 年、2016 年）、培训期间（2017 年）和培训停止后（2018 年）所有溶栓病例。主要结局参数为门到针时间。
门到针时间从干预前的 37 分钟减少到干预期间的 28 分钟（P<0.001）。在培训停止后，门到针时间呈增加的趋势，但无统计学意义（31 分钟）。住院医师（<6 年神经科培训；30.8-31.2 分钟）的表现保持不变，而专家的表现（>6 年神经科培训）则显著下降（从干预期间的 25.4 分钟到停止后的 31.7 分钟，P=0.047）。通过使用回归分析控制多种混杂因素，我们发现干预与改善患者结局之间存在显著关联（P=0.008）。
本研究结果表明，定期对最近的溶栓病例进行基于案例的讨论可改善脑卒中患者的治疗效果。停止干预后，效果在住院医师中持续存在，但在专家中则不明显。结果表明，住院医师知识的提高是表现改善的主要原因，而专家的表现则更多地受到动机的影响。
