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Table of Contents    
COMMENTARY
Year : 2019  |  Volume : 67  |  Issue : 1  |  Page : 134-135

Stroke-related education to emergency department staff


1 Department of Neurology, Janakpuri Superspeciality Hospital, New Delhi, India
2 Department of Pathology, Janakpuri Superspeciality Hospital, New Delhi, India
3 Department of Neurology, Virginia Commonwealth University, Virginia, USA

Date of Web Publication7-Mar-2019

Correspondence Address:
Dr. Man Mohan Mehndiratta
Department of Neurology, Janakpuri Superspeciality Hospital, C-2/B, Janakpuri, New Delhi - 110 058
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.253598

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How to cite this article:
Mehndiratta MM, Gulati NS, Mehndiratta P. Stroke-related education to emergency department staff. Neurol India 2019;67:134-5

How to cite this URL:
Mehndiratta MM, Gulati NS, Mehndiratta P. Stroke-related education to emergency department staff. Neurol India [serial online] 2019 [cited 2019 Jul 18];67:134-5. Available from: http://www.neurologyindia.com/text.asp?2019/67/1/134/253598




Acute stroke care and treatment is multifaceted in an emergency department; hence, the skills of an interdisciplinary team are required. The skill-enhancing stroke education of all team members including physicians, paramedical staff including nursing staff, technicians, rehabilitation therapists, pharmacists, and the reception staff as well as security personnel is, therefore, required. Education being one of the hallmarks of high-quality stroke care helps healthcare professionals to follow and line up with evidence-based clinical practice guidelines and enhance their performance and skills.[1] Equally important in an emergency department is prompt and timely treatment of acute strokes, both hemorrhagic and ischemic types. Time is the essence in the treatment of acute stroke patients.[2] Standardizing and framing an algorithm of stroke care in the emergency department, which is customized and tailor-made according to the existing manpower and infrastructure, can play a vital role in decreasing the time lag in stroke care. Hence, training and orienting the staff to this stroke care algorithm is very important.[3]

In addition to the hospital staff, continuous education and counselling needs to be imparted to patients and their care-givers also. It has been seen that the patients want information concerning their illness, condition, and treatment to be given, to their caregivers as it helps to promote the care-givers' participation in care, and also helps them orient to their situation.[4]

The emphasis should be not only on acute stroke education but also on imparting information about the risk factors and prevention. Prevention is always a go-to word in stroke care and prevention begins with education. The importance of prevention strategies and its potential to make an influence is unparalleled. Providing stroke education to our at-risk patients in the community is considered a critical part of the chain of survival, which includes patients and families, care-givers, and public at large. To achieve a global initiative to prevent stroke, stroke awareness can be disseminated by educating the community at large, including both lay persons as well as professionals through community events such as health fairs, schools, senior centres/residential facilities, religious places/libraries, organizations/clubs, sporting venues, etc. The second set of population who can be educated can be patients in the in-patient and out-patient units and in the emergency wards and reception areas. The third set of people who can be educated are the hospital staff. It should be noted that the education imparted must be individualized and repetitive, as repetition increases the retention of learned information. It should be initiated early in the patient's stay to allow time for reinforcement of the information.[5]

One of the objectives of the stroke education is to make available stroke education resources at an easy-to-find place that may be available throughout the year. The various resources which can be used can be books, journals, websites, social media messaging such as Facebook, Instagram, shareable graphics and animations, videos, public service announcements, brochures, flyers, banners, tweets, infographics, and handouts that are focused on disseminating information on stroke detection and care.

The original article written in this journal by Puri et al., “Stroke-related education to emergency department staff: An acute stroke care quality improvement initiative” rightly emphasizes on the professional education of doctors, paramedical staff, as well as the triage staff and security personnel in the Emergency Department.[6] In addition to that, it would be appropriate to standardize and organize the stroke education program by designating a stroke program manager who will frame a stroke education program, including orientation of new appointees, constructing a curriculum that covers all the important topics properly, formulates the timings and frequency of classes, conducts pre- and posteducational tests, give performance reviews, annually updates the curriculum, assesses the competency of the professionals, as well as constantly reassesses the need for further education and training. The training and education can be in the form of lectures/conferences, webinars, in-services trainings, journal club case conferences, etc. It has been observed that there is relative lack of tracking and auditing of work output of healthcare professionals and the absence of feedback mechanisms to the staff regarding individual work output. Designating a dedicated stroke education program manager will help in developing feedback mechanisms and in improving work performance.[7],[8]

Apart from educating the professionals about the various aspects of stoke care, they should also be oriented to the workflow of the Emergency Department. This is especially true for the new appointees who, as the junior residents, are appointed for a limited period of time, and new residents join once their tenure is completed. The workflow of the Emergency Department should be defined and documented in customized stroke care algorithms and should be displayed prominently at appropriate places in the department. A pocket diary can also made and handed over to all team members containing stroke care algorithms. Furthermore, this algorithm should be incorporated in the teaching curriculum of the stroke team members, including the doctors, nursing staff, and supporting staff. They should be regularly oriented and trained to follow the standardized algorithms framed regarding work flow in stroke care in order to reduce the time lag.

This is really important in a developing country like India, where, in an Emergency Department, there are manpower and physical infrastructural limitations as well as variability of care. So, in a resource-limited setting, significant delays are often seen in the treatment of patients with acute stroke. Delay in treatment in the hospital can be curtailed by framing and following appropriate stroke care algorithms.

Continuous efforts need to be made to reduce the time lag between the patient arrival and initiation of treatment by identifying the most time-consuming processes.[9],[10] The evaluation parameters which can be studied are symptom-to-door, door-to-physician, door-to-imaging, as well as door-to-needle timings. Evaluating these parameters can help to highlight the possible operational constraints and areas for improvement. Important time determinants of work flow need to be determined such as the triage time, waiting time, imaging time, intervention time, and admission time. Route cause analysis of the delay, if any, can be done and proper corrective and preventive measures should be undertaken to eliminate the underlying cause of delay.[2],[3]

To summarize, the need of the hour in stroke care is that the benefit of science reaches the patient promptly and appropriately. This can be achieved with the Emergency Department having a well-coordinated skilled stroke care team in place that is well-versed with stroke care algorithms at their work place. They should also have a sound knowledge of stroke care treatment protocols. The stroke care can, of course, be further enhanced by educating the community at large so that there is better patient compliance in treatment and care.



 
  References Top

1.
Middleton S, Grimley R, Alexandrov AW. Triage, treatment, and transfer: Evidence-based clinical practice recommendations and models of nursing care for the first 72 hours of admission to hospital for acute stroke. Stroke 2015;46:e18-25.  Back to cited text no. 1
    
2.
Shen Y, Lee LH. Improving the wait time to consultation at the emergency department. BMJ Open Qual 2018;7:e000131.  Back to cited text no. 2
    
3.
Gurav SK, Zirpe KG, Wadia RS, Naniwadekar A, Pote PU, Tungenwar A, et al. Impact of “stroke code”-rapid response team: An attempt to improve intravenous thrombolysis rate and to shorten door-to-needle time in acute ischemic stroke. Indian J Crit Care Med 2018;22:243-8.  Back to cited text no. 3
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4.
Paavilainen E, Salminen-Tuomaala M, Kurikka S, Paussu P. Experiences of counselling in the emergency department during the waiting period: Importance of family participation. J Clin Nurs 2009;18:2217-24.  Back to cited text no. 4
    
5.
Puri I, Bhatia R, Vibha D, Singh MB, Padma MV, Aggarwal P, Prasad K. Stroke-related education to emergency department staff: An acute stroke care quality improvement initiative. Neurol India 2019;67:129-33.  Back to cited text no. 5
  [Full text]  
6.
Rasura M, Baldereschi M, Di Carlo A, Di Lisi F, Patella R, Piccardi B, et al. promotion and implementation of stroke care in Italy project working effectiveness of public stroke educational interventions: A review. Eur J Neurol 2014;21:11-20.  Back to cited text no. 6
    
7.
Wa Coverdell Acute Stroke Program Stroke Education Toolkit. Washington State Department of Health [Internet] April 2016. Available from: https://www.doh.wa.gov/Portals/1/Documents/Pubs/346056.pdf. [Last accessed on 2019 Feb 11].  Back to cited text no. 7
    
8.
Marco M. A Computer-based stroke education orientation program for nurses on a designated stroke unit: A program development, quality improvement project. master's theses, dissertations, graduate research and major papers overview. 2017:181. Available from: https://digitalcommons.ric.edu/etd/181. [Last accessed on 2019 Feb 11].  Back to cited text no. 8
    
9.
Mehndiratta P, Mehndiratta MM. Barriers to thrombolytic therapy for acute ischemic stroke, in a developing country like India. Poster presented at American Academy of Neurology 63rd Annual meeting, 2011 April 9-16, Honolulu, Hawai.  Back to cited text no. 9
    
10.
Mehndiratta P, Mehndiratta MM, Balachandran V, Rani S, Garg RK. Awareness of stroke and reasons for delay in arriving to the hospital for early treatment. Poster presented at 6th World Stroke Congress, 2008 Sep 24-27, Vienna, Austria.  Back to cited text no. 10
    




 

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