Multiperspective simulations for implementing a change in service: stroke telethrombolysis

Background: Simulation-based training has been utilised in a variety of ways to demonstrate and improve process elements of patient care. One example of this is in improving door-to-needle times in hyper-acute stroke care. Changes in service by one team which affects another brings difference of opinions between service providers involved and can lead to inter-departmental conflict. Method:
In this report we use Kurt Lewin’s model for change to describe how a series of multi-perspective simulation-based exercises were used in implementing a change in practice with the introduction of tele-thrombolysis within a large tertiary stroke referral hospital. Results: The use of multiperspective or bi-directional simulation allowed a ‘meeting of minds’ with each service able to illustrate key themes to the other service. This was demonstrated through a series of simulationbased exercises. Conclusion: Following successful simulation-based exercises and subsequent interdepartmental agreement, a telethrombolysis pilot has been conducted within our centre. Ongoing audit of practice continues as this method of treatment delivery is continued. Further simulation work is planned as a national thrombectomy service is instigated.