SimLEARN Collaborates with National Tele-Stroke Program ‘Go-Live’ Training - VHA SimLEARN
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SimLEARN Collaborates with National Tele-Stroke Program ‘Go-Live’ Training

By LeAnn Schlamb, MSN, RN, Ed.S
SimLEARN Associate Director Education, Research, and Outreach
Michelle Regragui, MSHS, BSN, RN,
and Jane Robinson, MSN, RN, CEN
National SimLEARN Clinical Faculty, Nurses with the Simulation Outreach Network
SimLEARN National Simulation Center

ORLANDO, Fla. – The VA National Tele-Stroke Program (NTSP) is a collaboration with the VA’s Office of Rural Health and the Office of Neurology to improve access to acute stroke services for Veterans residing in rural communities. This is done by using mobile and telehealth technologies to bring acute stroke expertise to the bedside anywhere in the country.

The VA National Tele-Stroke Program has been implemented in 24 facilities, in which simulation was an integral part of training. VA facilities partnering with the NTSP participate in a three-day “Go-Live” training program to prepare them to recognize and treat acute stroke, while incorporating the use of mobile and telehealth technologies.

Before on-site training the NTSP team conducts site-surveys and multiple pre-coordination calls to determine potential barriers to implementation, coordinate training, mentor staff on the writing of policies and procedures and share lessons learned at other sites. For the “Go-Live” training, the target audience is an interprofessional team made up of representatives from different disciplines including, physicians, nurses, laboratory, and radiology personnel, and the VA police and others involved with treating Veterans experiencing the symptoms of acute stroke.

Day one training is facilitated by the National Tele-Stroke Program Team. Topics include the importance of early recognition and treatment of acute stroke based on best practice, a live demonstration of the tablet used when contacting a tele-stroke neurologist, and practice reconstitution of Alteplase using a commercially prepared demonstration kit. Alteplase is a thrombolytic drug, used to treat acute myocardial infarctions (heart attacks) and other severe conditions caused by blood clotting by breaking up the blood clots that cause them. The day ends with an interactive discussion with local staff to create a flow map of the current state of acute stroke care in the emergency department, intensive care unit and other areas identified by the facilities. This same team then creates a flow map of the ideal state incorporating the tele-stroke neurologist.  

Using the ideal flow map created on day one, the NTSP team and a faculty member from SimLEARN spend all of day two and part of day three conducting real-time simulations. Simulations take place in the emergency department, medical/surgical unit and the intensive care unit (ICU). All scenarios use a simulated patient (actor).

The scenario begins when a staff member recognizes a patient showing signs of an acute stroke. The team then goes through the actual care of the simulated patient, to include taking the patient to a CT scan, contacting the national tele-stroke consultant, the reconstitution of tissue plasminogen activator and documentation. Following each simulation and debriefing, the original process is reviewed and revised based on findings with proposed solutions for subsequent simulations.

Day three also provides teams an opportunity to review processes and flows, as well as revise the ideal state process map. The day closes with the NSTP team presenting their recommendations to leadership with projected readiness of a “Go Live” date. The outcome includes self-reporting of increased confidence among staff implementing a tele-stroke program. Facilities that have implemented a tele-stroke program allow for Veteran access to stroke specialists 24/7.