Huang Ganying, Yang Huijie, Yao Huan, Fan Xinxin, Xia Wenqin, Xu Yuansheng, Shen Xiaoling, Zhao Xue
Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310053, China.
Emergency Medicine Departent, Hangzhou First People's Hospital, Hangzhou 310006, China.
World J Emerg Med. 2024;15(1):41-46. doi: 10.5847/wjem.j.1920-8642.2023.084.
Ischemic stroke refers to a disorder in the blood supply to a local area of brain tissue for various reasons and is characterized by high morbidity, mortality, and disability. Early reperfusion of brain tissue at risk of injury is crucial for the treatment of acute ischemic stroke. The purpose of this study was to evaluate comfort levels in managing acute stroke patients with hypoxemia who required endotracheal intubation after multidisciplinary simulation training and to shorten the door-to-image time.
This quality improvement project utilized a comprehensive multidisciplinary simulation exercise. A total of 53 participants completed the two-day simulation training. The main outcome was the self-reported comfort levels of participants in managing acute stroke patients with hypoxemia requiring endotracheal intubation before and after simulation training. A 5-point Likert scale was used to measure participant comfort. A paired-sample -test was used to compare the mean self-reported comfort scores of participants, as well as the endotracheal intubation time and door-to-image time on the first and second days of simulation training. The door-to-image time before and after the training was also recorded.
The findings indicated that simulation training could enhance participant comfort when managing acute stroke patients with hypoxemia who required endotracheal intubation and shorten door-to-image time. For the emergency management of hypoxemia or tracheal intubation, the mean post-training self-reported comfort score was significantly higher than the mean pre-training comfort score (hypoxemia: 4.53±0.64 vs. 3.62±0.69, = -11.046, <0.001; tracheal intubation: 3.98±0.72 vs. 3.43±0.72, = -6.940, <0.001). We also observed a decrease in the tracheal intubation and door-to-image time and a decreasing trend in the door-to-image time, which continued after the training.
Our study demonstrates that the implementation of simulation training in a clinical environment with a multidisciplinary approach may improve the ability and confidence of stroke team members, optimize the first-aid process, and effectively shorten the door-to-image time of stroke patients with emergency complications.
缺血性卒中是指因各种原因导致局部脑组织血液供应紊乱，其特点是发病率、死亡率和致残率高。对有损伤风险的脑组织进行早期再灌注对急性缺血性卒中的治疗至关重要。本研究的目的是评估多学科模拟训练后管理需要气管插管的急性低氧血症卒中患者时的舒适度，并缩短从入院到影像检查的时间。
本质量改进项目采用了全面的多学科模拟演练。共有53名参与者完成了为期两天的模拟训练。主要结果是模拟训练前后参与者管理需要气管插管的急性低氧血症卒中患者时自我报告的舒适度。使用5点李克特量表来衡量参与者的舒适度。采用配对样本t检验来比较参与者自我报告的平均舒适度得分，以及模拟训练第一天和第二天的气管插管时间和从入院到影像检查的时间。还记录了训练前后从入院到影像检查的时间。
研究结果表明，模拟训练可以提高管理需要气管插管的急性低氧血症卒中患者时参与者的舒适度，并缩短从入院到影像检查的时间。对于低氧血症或气管插管的紧急处理，训练后自我报告的平均舒适度得分显著高于训练前的平均舒适度得分（低氧血症：4.53±0.64 vs. 3.62±0.69，t = -11.046，P <0.001；气管插管：3.98±0.72 vs. 3.43±0.72，t = -6.940，P <0.001）。我们还观察到气管插管时间和从入院到影像检查的时间减少，且从入院到影像检查的时间呈下降趋势，训练后仍持续。
我们的研究表明，在临床环境中采用多学科方法实施模拟训练可能会提高卒中团队成员的能力和信心，优化急救流程，并有效缩短有紧急并发症的卒中患者从入院到影像检查的时间。
