Table 2 Characteristics of included studies
Author; year, country | Participants, setting, | Intervention (type of simulation training) | Length of training | Outcome measure | MERSQI |
|---|---|---|---|---|---|
Tahtali et al. 2016 [47] Germany | Number of patients: • Pre-simulation training: 50 patients • Post-simulation training: 83 patients Number of learners: 151 Healthcare professionals: 8 neurology specialists, 39 neurology residents, 8 neuroradiology residents, 28 emergency department nurses, 5 neuroradiology and medical-technical radiology assistants, 57 students, and 6 external guests Hospital: Neurological Emergency Room at the Centre for Neurology and Neurosurgery | The simulation training includes a remote-controlled manikins, connected to a real clinic monitor, that is used for the simulated scenarios with variable circulatory parameters throughout the simulation. The stroke team simulation was based on the concepts of Crew Resource Management | Monthly training in small groups with up to eight participants, consisting of new stroke team members, for 2 years | Door-to-needle timea Improvement in intravenous thrombolysis knowledge Feeling safe making decisions in acute stroke care Improvement in communication | 12.0 |
Waterson et al. 2016 [48] United Kingdom | Number of patients: not specified Number of learners: not specified Healthcare professionals: medical and surgical staff Hospital: emergency department | In-situ simulation training (simulated scenarios) | One-off simulation training session | Door-to-needle time | 11.0 |
Ohara et al. 2017 [49] Japan | Number of patients: • Pre-simulation training: 46 patients • Post-simulation training: 36 patients Number of learners: not specified Healthcare professionals: acute stroke team (multidisciplinary team) Hospital: (single centre)—not specified | Simulation training by organising in-hospital lectures and simulation training courses | Not specified | Door-to-needle time | 11.5 |
Richardson et al. 2017 [50] USA | Number of patients: not specified Number of learners: 4 Healthcare professionals: Neurology residents (first years—PGY-1) Hospital: simulation-based learning environment | Simulation-based learning scenarios were developed, using a manikin controlled by the simulation lab personnel. Participants were videotaped performing the scenario, which was incorporated into their debrief | One-off simulation training session | Door-to-needle time | 12.0 |
Ruff et al. 2017 [51] USA | Number of patients: • Pre-simulation training: 72 patients • Post-simulation training: 98 patients Number of learners: 15 Healthcare professionals: Neurology Residents (PGY-2, PGY-3, and PGY-4) Hospital: emergency department | Case-based simulation course with Socratic presentation of acute stroke cases (based on 4 scenarios). The boot camp was facilitated by senior residents, stroke fellows, and stroke attending physicians | One-off resident bootcamp | Door-to-needle timea Improvement in intravenous thrombolysis knowledge | 11.5 |
Tahtali et al. 2017 [52] Germany | Number of patients: • Pre-simulation training: 122 patients • Post-simulation training: 112 patients Number of learners: 176 Healthcare professionals: physicians, nurses, and technicians) participated in on-site stroke team simulation training from seven hospitals. 152 healthcare professionals completed the questionnaires from 6 stroke units (University Hospital Frankfurt did not participate) Hospitals: (Interdisciplinary Neurovascular Network)—three comprehensive and four regional stroke units (total of seven stroke units) | Train-the-trainer seminar to educate stroke team trainers for each stroke unit conveying the principles of Crew Resource Management Simulation-based training with the simulation team in each participating hospital using a high-fidelity manikin. The remote-controlled high-fidelity manikin, connected to a lifelike monitor, was filled with artificial blood, and placed on a stretcher, mimicking stroke-like symptoms | Two and a half hours of stroke team training over 2 months throughout the seven participating hospitals | Door-to-needle timea Improvement in intravenous thrombolysis knowledge Self-perceived usefulness of simulation training Feeling safe making decisions in acute stroke care | 13.0 |
Tse-Chang et al. 2017 [53] USA | Number of patients: not specified Number of learners: 187 Healthcare professionals: 153 emergency department nurses, 8 emergency department physicians, 6 neurologists, 4 pharmacists, 6 radiology technicians, and 10 phlebotomists Hospital: Emergency Department | The simulation training included code stroke responders (five nurses) and the scenarios demonstrated right hemispheric syndrome. Participants in the simulation took a focused history and relayed their findings to the neurologist to evaluate the inclusion/exclusion criteria and the administration of thrombolysis | One-off simulation training session with a 90-min scenario | Door-to-needle time | 12.0 |
Windle et al. 2017 [54] Australia | Number of patients: not specified Number of learners: not specified Healthcare professionals: Stroke team, emergency, and clinical education clinicians, in addition to radiology, anaesthetics, administration and communications staff Hospital: tertiary centre. Off-site (hospital simulation centre) and in-situ simulation (emergency department) | Phase I of the simulation training included patient scenario for the stroke team Phase II was the in-situ simulation in the emergency department; video footage was used to guide improvement | Four off-site simulations and one in-situ simulation for stroke education | Door-to-needle time | 10.5 |
Zidan et al. 2017 [55] USA | Number of patients: • Pre-simulation training: 34 patients • Post-simulation training: 41 patients Number of learners: 13 Healthcare professionals: Resident physicians (7 PGY-2 and 6 PGY-3) Hospital: Simulation Lab | Mock cases (clinical scenarios) of code stroke, were created, replicating real-life events on standardised patients. The cases included clinical vignettes | Thirteen stroke cases over one day (the cases included history of symptoms, lab data, and radiological images) | Door-to-needle timea Improvement in intravenous thrombolysis knowledge | 12.0 |
Carvalho et al. 2018 [56] Brazil | Number of patients: • Pre-simulation training: 90 patients • Post-simulation training: 199 patients Number of learners: 122 Healthcare professionals: from stroke facilities and pre-hospital care Hospital: three emergency clinics and two hospitals | Case vignettes of a fictitious scenario, involving healthcare professionals as members of the team/patients family with challenges such as anxious family members and emergency department staff making wrong decisions. The simulated cases are based on a manikin (ALS Simulator, Laerdal Medical) able to mimic blood pressure, heart sounds, peripheral pulse, ECG, simulates the patient on a hospital bed | Eighteen training sessions over 11 months | Door-to-needle timea | 13.0 |
Haesebaert et al. 2018 [57] France | Number of patients: • Pre-simulation training: 328 patients • Post-simulation training: 363 patients Number of learners: 72 Healthcare professionals: emergency physicians and nurses Hospital: 18 emergency units (simulated environments) | Interactive simulation using clinical cases played by two stroke unit nurses to identify the Face Arm Speech Time tool for stroke detection Simulation training by physicians to perform the National Institutes of Health Stroke Scale score after watching the French national neurovascular society video on simulated patients | One day of training Aimed to improve the knowledge and skills of triage nurses in detecting strokes and using the National Institutes of Health Stroke Scale score by emergency physicians | Door-to-needle timea | 14.5 |
Mehta et al. 2018 [58] USA | Number of patients: • Pre-simulation training: 172 patients • Post-simulation training: 276 patients Number of learners: 20 Healthcare professionals: PGY-2 neurology residents Hospital: neurology department | Mock code stroke simulations used trained live actors (neurology nurses), portraying stroke vignettes and depicting focal neurological findings correlating with each case | One session over one day, every year for current PGY-2 neurology residents | Door-to-needle timea | 13.5 |
Sanders et al. 2018 [59] Australia | Number of patients: not specified Number of learners: not specified Healthcare professionals: stroke team Hospital: not specified | Simulation training was based on a real case of right middle cerebral artery occlusion and was adapted depending on the skill set of each participating group. The scenarios included simulated patients | One session every rotation over 1 year | Door-to-needle time | 11.0 |
Ajmi et al. 2019 [60] Norway | Number of patients: • Pre-simulation training: 399 patients • Post-simulation training: 190 patients Number of learners: 210 Healthcare professionals: stroke physicians, radiologists, paramedics, interventional radiologists, emergency room nurses, neuroradiologists, radiographers, and neurology registrars Hospital: stroke units and emergency rooms | Previous stroke patients acted as simulated patients for the in-situ simulation-based training sessions that included scripted scenarios, mimicking real-life cases | One weekly session (lasting approximately 60 min) with a 4-month pause. Total of 20 simulation sessions | Door-to-needle timea Self-perceived usefulness of simulation training | 13.0 |
Singh et al. 2019 [61] USA | Number of patients: not specified Number of learners: 24 healthcare professionals: internal medicine residents Hospital: community hospital | Acute stroke simulation included two different case scenarios using standardised patients (one acute ischaemic stroke case within 3 h and an acute ischaemic stroke within 24 h). The simulation session was videotaped | One-off session for all internal medicine residents at a community hospital before starting stroke calls | Door-to-needle time | 9.0 |
Bubel et al. 2020 [62] Austria | Number of patients: not specified Number of learners: not specified Healthcare professionals: acute stroke care (interdisciplinary team) Hospital: emergency department | Simulation training intervention—details not specified | Not specified | Door-to-needle time | 11.5 |
Bohmann et al. 2022 [63] Germany | Number of patients: • Pre-simulation training: 175 patients • Post-simulation training: 169 patients Number of learners: 186 Healthcare professionals: Stroke team [40% residents, 7% specialist physicians, 18% senior physicians, 20% nurses, 4% students, 6% others (laboratory and radiology technicians)] Hospitals: Seven tertiary care neuro-centres in emergency departments of university hospitals | Theoretical introductions based on Crew Resource Management which was the stroke teams’ basis for the in-situ simulation. Simulation was structured as briefing → simulation → debriefing Simulation training of scripted simulation scenarios used high-fidelity manikins with a monitoring system to provide the cardiorespiratory alarms and standardise the simulation to focus on team communication. CT scans were used to present radiological findings | Two full days of stroke team training at each of the seven sites lasting approximately 3 h. No participant received more than one training | Door-to-needle timea Self-perceived usefulness of simulation training | 13.0 |
Rhew et al. 2022 [64] USA | Number of patients: not specified Number of learners: not specified Healthcare professionals: emergency department nurses Hospital: simulation lab | At the simulation skills fairs in the simulation lab, stroke simulation scenarios were performed by groups of nurses in the care of code stroke patients (details not specified). The simulation was facilitated by an experienced emergency department nurse | Emergency Department nurses were required to attend one of five simulation skills fairs offered over a 9-month period | Door-to-needle time | 9.5 |
Svobodova et al. 2023 [65] Czech Republic | Number of patients: • Pre-simulation training: 14,046 patients • Post-simulation training: 3088 patients Number of learners: 94 Healthcare professionals: 62 physicians (mostly neurologists) and 32 nurses Hospital: equipped simulation centres | Two rounds of simulation scenarios (briefing → simulation → debriefing → conclusion) Scenarios were based on real life thrombolytic cases adapted for educational purposes, with hospital staff acting as simulated patients | Half-day simulation training spread over 10 courses | Door-to-needle timea Self-perceived usefulness of simulation training Improvement in communication | 12.5 |