title: [Crew resource management and simulator training in acute stroke therapy].
abstract: BACKGROUND
  Time is of critical importance in acute stroke management. The establishment of thrombectomy now adds to the complexity and interdisciplinarity of the initial phase. In non-medical high-fidelity situations, such as aviation, crew resource management (CRM) has proven to be highly efficient. It has therefore also been implemented in professional cardiovascular life support training. In a setting where every minute counts, CRM and regular training of the high-fidelity stroke team could offer ways to improve treatment of acute stroke patients.
  
  
  OBJECTIVE
  We evaluated the effects of a CRM-based stroke team with regular simulation training on the quality of care (e.g. door to needle time and thrombolysis rate) as well as on staff satisfaction and perceived patient safety in the emergency department of a tertiary care neurocenter.
  
  
  METHODS
  We implemented a dedicated stroke team consisting of 7 persons who are notified by a collective call via speed dial and conceived a simulator-based team training for all new stroke team members which we conduct at monthly intervals. We recorded door to needle times of all consecutive patients, staff satisfaction in the emergency room and the acceptance of this new learning format.
  
  
  RESULTS
  This approach led to a relevant and sustained reduction of the mean door to needle time to less than 30 min. It improved perceived patient safety in residents with professional experience of less than 2 years. There was a very high acceptance within the stroke team training and staff and its usefulness was judged to be very high.
  
  
  CONCLUSIONS
  Even though our data do not allow positive effects on patient outcomes to be inferred, the implementation of a CRM-based stroke team and simulator training has had multiple positive effects on the workflow and work satisfaction in the treatment of acute stroke patients.
authors.affiliation: Klinik für Neurologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
authors.forename: D
authors.initials: D
authors.lastname: Tahtali
authors.affiliation: Klinik für Neurologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
authors.forename: F
authors.initials: F
authors.lastname: Bohmann
authors.affiliation: Anästhesie und Intensivpflege NICU, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
authors.forename: P
authors.initials: P
authors.lastname: Rostek
authors.affiliation: Geschäftsstelle Qualitätssicherung Hessen (GQH), Eschborn, Frankfurt, Deutschland.
authors.forename: B
authors.initials: B
authors.lastname: Misselwitz
authors.affiliation: Geschäftsstelle Qualitätssicherung Hessen (GQH), Eschborn, Frankfurt, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Reihs
authors.affiliation: Frankfurter interdisziplinäre Einrichtung für Notfallmedizin und Simulationstraining (FINeST), Goethe-Universität Frankfurt/Main, Frankfurt/Main, Deutschland.
authors.forename: F
authors.initials: F
authors.lastname: Heringer
authors.affiliation: Klinik für Neurologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
authors.forename: K
authors.initials: K
authors.lastname: Jahnke
authors.affiliation: Klinik für Neurologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
authors.forename: H
authors.initials: H
authors.lastname: Steinmetz
authors.affiliation: Klinik für Neurologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland. w.pfeilschifter@med.uni-frankfurt.de.
authors.forename: W
authors.initials: W
authors.lastname: Pfeilschifter
mesh_terms: D002983:Clinical Competence; D003422:Critical Care / Q000379:methods; D004632:Emergency Medical Services / Q000379:methods*; D005858:Germany; D000070856:High Fidelity Simulation Training / Q000379:methods*; D006801:Humans; D010348:Patient Care Team / Q000458:organization & administration; D016544:Patient Simulation; D012151:Resuscitation / Q000193:education*; D020521:Stroke / Q000175:diagnosis / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods*
keywords: Patient safety; Simulation; Stroke; Thrombolysis; Training