← Becker’s Healthcare Podcast
Loading summary
Transcript24 lines
- [00:00]
A
The recommendations and opinions presented by our guest speakers may not represent the official position of the American Heart Association. The materials are for educational purposes only and do not constitute an endorsement or instruction by the American Heart association or the American Stroke Association. The American Heart association and American Stroke association do not endorse any products or services. Hello everyone. This is Erica Spicer Mason with Becker's Healthcare. Thank you so much for tuning in to the Becker's Healthcare podcast series. So today we're going to talk about stroke. And just to give listeners a little bit of background, stroke is a leading cause of death and disability worldwide, and faster recognition can mean the difference between full recovery and lasting harm. But for many healthcare providers who don't regularly treat stroke patients, that foundational knowledge isn't always part of their training. So today we're going to talk about the Essential Stroke life support, or ESLs course. And this is developed by the American Heart association and American Stroke association in collaboration with the University of Miami's Gordon center for Simulation and Innovation in medical education. ESLs is a self paced elearning program that's designed to close that stroke knowledge gap for nurses, EMTs and other pre hospital and in hospital providers. Joining us for the conversation we have Dr. Yvette Mottola, professor of Emergency Medicine and Professor of Medical Education at the University of Miami, Miami Miller School of Medicine. And she's also the Associate Director of the Gordon center for Simulation and Innovation in Medical Education. And we also have Harold Mayfield, who is a training coordinator at Richmond Ambulance Authority and who has already brought ESLs to his team. Dr. Mottola, Harold, welcome to the podcast. So glad to have you both with us today.
- [01:52]
B
Thank you.
- [01:53]
C
Thank you so much, Erica. It's great to be here.
- [01:56]
A
So glad to have you both. And before we get into the conversation, I'm hoping for just a quick introduction from you both. Can you share a little bit more about your roles and the work that you're focused on right now? And Harold, would you like to get us started?
- [02:09]
B
Sure. So I am the training coordinator with Richmond Ambus Authority. We handle all the EMS911 for the city of Richmond here in Virginia. Part of our process is making sure that we are better equipping our providers on how to help the citizens here in Richmond. And we came across the central stroke life support course and just thought that was a great way to kind of fill in some gaps.
- [02:36]
A
Fantastic. Thank you so much, Harold. And Dr. Mottola, tell us a little bit more about yourself.
- [02:41]
C
Thanks again. I'm happy to to share a little bit about My background, I'll focus on stroke, but I am an emergency medicine physician by clinical training and background. But I've been doing primarily simulation based healthc education for over 19 years now. It's almost been two decades here at the University of Miami Gordon Center. And when I first started working here, I inherited this amazing program called Advanced Stroke Life Support, which had been developed to improve recognition and management of stroke patients. Shortly after the first trials came out showing that we could use thrombolytics in acute ischemic stroke, which was truly a game changer. This was all the way back in the 1990s. And you know, it's taken us a while to get to where we are, but it's been a really exciting, exciting journey, especially for stroke patients and their families. And so our approach, since we're a simulation based healthcare education, is how do we leverage both technology best practices in adult and healthcare education as well as, of course, simulation and which things can we do effectively and efficient remotely, which will come up as we discuss ESLs and you know, which things do we really need to do in person for practice of skills? And so that's another big area. So I have many passions, as most emergency physicians and emergency folks have, but a lot of them focus really around these things. How to use technology and simulation effectively for healthcare education. And of course, team training, team work efficiency and effectiveness when we have crisis critical situations like stroke. And then of course, stroke education and training.
- [04:24]
A
Fantastic. Great to learn a little bit more about your approach at a high level, Dr. Mottola and I wanted to start with you first, just to get a little bit of a better understanding of the specific gaps or breakdowns that you have seen in stroke education that kind of inspired you and your team to pursue ES ls. And as you've collaborated with the American Heart association and American Stroke association, how did you approach building it differently from existing training models that you previously worked with?
- [04:54]
C
Great questions. Thank you, Erika. So we, as I, as I alluded to before, we had been teaching advanced stroke life support for nearly two decades when we had also started realizing that there was a gap. You know, the advanced course is great for all those healthcare professionals that are primarily taking care of stroke patients and are in our more advanced scope of work providers. But as you said, when in your wonderful introduction, there is such a time sensitivity to stroke if we don't get everyone on board to be able to detect or at least think that the patient's having a stroke and then rapidly get them to where they need to go to get the available treatments, then we're not going to have the impact that we know we can and want to have to reduce both death and disability from, from this terrible disease. So that's really where the gap came from in tr. So many folks, not just all over the US but also in many countries in the world, we realized that where the advanced stroke life support was definitely needed, there was a gap in what we call the more basic or essential course to have everyone be able to recognize this patient or this person is potentially having a stroke, recognize that and then what do I need to do? What are the next steps that I need to do? And that's really where ESLs was born from. When we were implementing and disseminating ASLS all those years, we really got to an amazing place where we had 125 training centers and I think it was 37 states altogether and 13 countries. We really had quite a bit of reach. But we also knew that as a simulation center at a medical school, we had taken it as far as we could with growth. And the need was so much bigger than that. The American Heart association was just such an obvious and wonderful partner. Our missions are very well aligned and they also wanted to do more work building off of their long standing resuscitation training programs, wanted to get more into the stroke education space. It actually began right around the time of the pandemic. So this was a course in its new iteration with ASLS blended learning and then ESLs that was born out of much work during the pandemic. In addition to other things that we were all doing. Of course during that time. We actually have a third partner with regards to technology in this program which is. You touched on how did we decide to build it and how is it different from other models? So the ASLS course is a blended learning course. And what we mean by that is that there's an elearning online component and then there's an in person training center simulation based component. And that is really great to have that practice and feedback in person for those skill sets. But we knew with ESLS from both our experience and the AHA experience that to reach as many healthcare professionals, and I would say, you know, allied health professionals all over the world that we wanted to, we needed to really leverage our computer based technologies because having, you know, these professionals come in person is great, but also is a lot more logistics, planning time, all of those kinds of things. And so we partnered with Laerdale Medical to develop these virtual simulations as the application component of the course. So the course really does leverage some of the best practices in technology and healthcare education with the Elearning program that we can discuss a little bit more about its individualized adaptive uses AI since we know we have to say AI and everything. But actually before it became the hot topic buzzword that it is now, it does leverage AI to determine each individual's path through it. And then the second part are these virtual simulations where the learners have to detect, manage, evaluate patients that potentially a stroke, figure out what's going on with them and then implement what we call the first few minutes or the first five minutes of what they need to do for these patients, determine where they need to go in their stroke system of care and do a full handoff, whether that's by EMS radio report or through sbar, which is what we use in the hospital.
- [09:26]
A
Such a great overview, Dr. Mottola. Appreciate everything you've shared about what this blended approach looks like and especially how you grounded some of the reasoning or the gaps in this mindset of if we don't get everyone on board to detect or even think that someone might be having a stroke, then then we're not going to have the impact that you'd like to have. So really interesting to hear kind of the impetus of this program and and your goals. So I'd like to turn it to Harold next to learn what this looked like from your perspective. Harold, at Richmond Ambulance Authority, what gaps were you seeing in stroke recognition and triage among your crews? And after implementing the ESLs program, can you share any changes that you've seen in terms of confidence, decision making or direct patient care?
- [10:13]
B
Yes, absolutely. So initially one of the biggest things that I saw was well, first of all for the EMT curriculum or the paramedic curriculum, strokes is obviously talked about. But I don't think there's not enough education being put out about the appropriate testing or assessment tools that you can use. Now I do understand because there are so many out there, whether you're Talking about Cincinnati BFast, Los Angeles Scale, like there's so many scales out there. I one of the biggest ones that always I could never get my mind around that people would do would when we talk about balance issue and they would ask the questions, you know, have you had any problems walking or anything like that? But then you'd have some people that actually tell ask the patient to stand up. And to me that was like that's just not. That's not a good response because the last thing I want them to do is stand up and then fall down. Now I have A traumatic stroke as well. So one of the things I really liked about the program was gave a good systematic approach. It goes into, you know, you can pick and choose which assessment tools you like to use, and it works with you in regards to that. And it actually lets you see somebody doing that full exam on somebody and seeing, oh, well, by doing a coordination test that does handle the same thing as the balance test, since that part of the brain is both controlled the same. So, you know, seeing that nice systematic approach and seeing how it should be properly done made it easier and then helped close that gap of that lack of information that's given. I currently teach EMT classes, basic entry level ENT all the time. And it's like I said, just with the curriculum, they have to do such a broad scope because it's a national curriculum. You know, they don't buy into this one or this one, and whether it's Cincinnati Bfast or anything like that. So therefore, they just don't really hit any of them. So this helped really close that gap. And what we did is we actually with, once our classes are done, we then assign them this course to help, you know, give that little boost of education in regards to that. But I'll be honest with the. The confidence. I can definitely see a change in, you know, people after taking this course, they understand the actual assessment they need to do. They have a great understanding of it, therefore they're able to run through it A, smoother, but B, also faster, which, as we've already talked about earlier, you know, time is of the essence in this. So not only are they doing a proper exam, but they're actually doing it faster than they were because they're a little bit more comfortable with it now, which is great. And even our area hospitals have, you know, they. They bring us in for luncheons and stuff here recently, and there's talking about how, you know, our. One of our crews brought in this patient and this patient and this was their outcome. And it's. It's been great feedback in a positive way. They've. They've definitely said, you know, out of our locale because we have. We handle the city of Richmond, but then we have other locales that are kind of out just outside the city. And basically we were just told we're on top of our game when it comes to this. And I do think this extra education that we're giving our providers is what's helping with that.
- [13:34]
A
Yeah. Harold, I appreciate you sharing what you were seeing on the ground before implementing ESLs and now, the change in confidence that you're seeing, I imagine, imagine that's very rewarding. You know, I'd also like to know too, just a brief snapshot of what implementing the ESLs program looked like from your end, you know, especially as leaders are concerned about, you know, taking too much time for implementation or perhaps complexity. So we'd love to get a few words from you on that and what your experience was.
- [14:05]
B
Yeah, so we have, you know, at the time that we, that I talked to my chief and he gave me the green light for this, we already had 100 and 100 and some providers who were already out in the field doing their thing. So we wanted to get them spooled up. So what I had to do is actually just broke them in two groups. So I got everyone who was already part of our company, all them done within a three month period. I just gave them a little bit of time and just gave them a hard deadline of it had to be done. And if it's not done, then you're not gonna be able to clock in. And then after that, how we've been rolling it out is every time we have a new employee orientation, we include that in our orientation. So we have other training as well that we do specifically here. So what we do is we give them all this training that they have to complete before they can actually be cleared to be out in the field on their own. So therefore, anybody new coming in will be at the same time, same level as the people who are who have already been working with us.
- [15:10]
A
Great to hear how that worked for your team, Harold. And Dr. Mottola, I'd like to turn it to you again. You know, I know you mentioned you described earlier in your response that the ESLs program really is designed for those who aren't regularly treating stroke patients or treating them closely or on a daily basis. I'd love to know how, in light of that, how did you prioritize or simplify this curriculum to make it accessible while still maintaining that clinical rigor that's needed?
- [15:42]
C
Thank you. Yeah. So I think anytime we start thinking about how we're going to build a curriculum, our first focus is of course, who's our target audience and what do they need to know to be able to do the work we're asking them to do or do this effectively? And so the way that I think about this is ESLs is really for any healthcare professional that works with patients at risk for stroke. Again, they may not be the nurse in the stroke unit or in the emergency department or they may be an EMT versus a paramedic with a reduced scope of work, but they're the ones that are seeing patients that are at risk for stroke, or again, folks that are working at home, are home health aides or in assisted living facilities. So all of the folks, all of the potential personnel that are working with patients at risk for stroke, that's really what we wanted to think about when we were building ESLs. The challenge in the task force was how do we include the content that it is a broad group would need and then how do we make it applicable for them? Harold already touched on one really important thing, which is there's a lot of different stroke screening exams out there as well as a lot of stroke severity scales. And the most common ones that are used, we include in the programs. So ESLs has several, and then ASLS is an even more expanded group. But what we want is people to really know how to do that correctly. And his point was a really good one and one that we see really all over, which is that, you know, personnel, whether that's EMS or even in hospital, are supposed to implement, you know, X screening exam, let's say bfast, and they're given a brief in service or some information around it and then supposed to implement it. But then when we actually go and see and have them demonstrate it, there's a lot of variability. So the actual level of familiarity and being able to do it correctly and what they're looking at is really variable. And so we want to streamline that as much as possible. And a good analogy and some of the things that we've been working on in the stroke space is to make it similar to the other really time sensitive things that we've had systems of care and training in for a while, like heart attack, like trauma, where everyone in the team is on the same page and speaking the same language. And so the examination is, you know, for stroke is really like our electrocardiogram in heart attack. Like we need everyone to know what they're looking at, what are the signs that are concerning and then what do we need to do when we find them. And so that's, that's really what we're focused on. So we wanted to strike that balance between, you know, what is, you know, as we like to say, the essential information, right, that they need to know from the knowledge perspective and then from the skills perspective. And that's what drove us. But everything that we do follows the sort of best practice in healthcare education. One of the most commonly used approaches is called the Kearns model, where we start with a needs analysis. And this is all the things that I mentioned around who's the audience, what's the gap? The things that you've been asking about are the same questions that we ask and having those conversations and then going through the process of developing our learning objectives, the metrics related to that, because it's in this adaptive mastery based format. And I'll talk a little bit more about that because it is really both interesting and I think one of the strengths of the program. With this program there isn't a pretest and a post test and if you have like a minimum passing score, say of 80%, then you're, then you're through it. Everyone has to answer and have the knowledge that's in the program, that's the mastery piece, regardless of how long that takes you. And so this individualized approach and journey through the program, the elearning program is done. So that is really based on your ability to show that you have competency and mastery of the knowledge. And so if someone doesn't get a question correct, then they'll be given the opportunity to review the content again and then given a related question to that learning objective. And they'll do that as many times as they need to show that they actually have mastery of the information and the knowledge. And so that is, is one both really unique and also allows for this individualization which again has several things that go into it. But this is one of the biggest pieces. But that's the other part that drove. So we had to develop the learning objectives, the metrics around those learning objectives. And then one of the great things about having the elearning format is that it's really rich in graphics, animations, photos, videos, having these visual things and being able to see what a stroke patient looks like, what does a facial droop look like, what does an arm weakness or drift look like is really helpful. And we know that it helps it stick in our brains so that when we see it again, our brains are really great at pattern recognition. So when we see it again we're like, oh wait, that's what that is. We've all done elearning courses at some point. We have a lot of requirements at work, especially in healthcare because it's highly regulated for all the obvious reasons. And you know, so we all have our learning that we have to do on a regular basis. And historically a lot of that once it became computer based because of its efficiencies, are someone's putting it on the side of their monitor or on a different monitor and having it play while they do other things. So clearly not the best learning environment. They're constantly interacting with the program. There really isn't anything that they can just sort of hit play and ignore on the side because they're being asked to answer probes in lots of different ways and interact with the content itself. And so it really is quite different than. And a lot of that we wanted to reach, as many of the healthcare professionals that we just discussed that are working with patients at risk for stroke, not only in the US but worldwide and this platform, and then having the virtual simulations as the application component allows us to do that in the shortest time possible. And that's really what we're trying to do. And especially because we know the need for this education and training, as Harold really nicely summarized, is, is so big.
- [22:21]
A
Yeah. Dr. Mottola, everything that you've described really underscores how much intention was put behind the program and curriculum development. Not just filling those gaps and who is able to adequately respond to someone who may be having a stroke, but just even at the individual level and accommodating different learning needs. You know, we're talking about various formats and engagement tactics to get folks really interested in the content and to make it accessible to them. So really appreciate the overview. And as we close our time together, I wanted to give our listeners a little bit of forward looking insight from you both. You know, we're seeing care teams now deliver care in many different settings. Whether we're talking virtually out in the community, care teams are certainly becoming more distributed. But at the same time, that time to treatment factor in stroke remains absolutely essential. So keeping that in mind, how do you both see stroke education evolving from here? And Harold, would you like to get us started on that one?
- [23:23]
B
Sure. I mean, I'll just go back to like my previous comment. I mean, the education that people are getting for their basic certifications, whether it be EMTB or paramedic, you know, it's just not hit enough. And so I think the, the more of this information that's out, the better the knowledge these people are going to have. The more comfortable you're going to feel with doing the right assessments. Just the better the possible outcomes will be. I mean, because just like y' all said before, it's, it's, you know, this isn't the call that you're running, you know, nine, nine times out of ten, all right, this is probably the one out of ten that you're actually running and you know, you need to Be just as proficient with that. And I think with this knowledge, it definitely helps make it for everyone, should be ready for it. And the more accessible, I mean, being able to have just, just good education at your fingertips. I mean, although we're doing a podcast now, but this, this, this course is more than a podcast. It's going to be, it's, it's designed to get the best possible outcome out of a provider. Just like, you know, the treatment that you're going to get from this is going to give you the best possible outcome for the patient. So I stuff like this is just, it's great and very accessible. So everyone should be taking this.
- [24:39]
A
Thanks, Harold. And Dr. Mottola, any final thoughts from you on this?
- [24:44]
C
Yes, Erica. So I wanted to say a couple things before sort of thinking even forward. We had the wonderful opportunity with the first group of over 1,000 learners that went through the course in getting feedback from them. And you know, to what Harold is saying, what we ultimately care about is what are the patient outcomes? Are we detecting them quickly and early enough? Are they getting to the right facility or the right part in the hospital to get the care that they need? And is that being done quickly and effectively? So we had really great feedback that participating in the course improved their stroke assessment skills, their recognition and differentiation, as well as earlier escalation, including clinical decision making, prioritization, communication, handoff, and these are the things that we know lead to those improved patient outcomes. So it was really exciting to share that data and analysis at the International Stroke Conference. I'm hoping that organizations like Harold's Enrichment Ambulance will also look at those things because we know that showing the impact of these courses and also helps adoption by others. And so I think where we are right now and in the near future is we need to get this training to as many healthcare professionals, agencies and organizations worldwide as possible so that we're all speaking the same language that Harold alluded to. And then going forward, we're always thinking again about how do we leverage technology and additional resources for training for all the things that you talked about, both being able to impact as many people as possible, but then, and also keeping learners engaged. And so some of the things that we're exploring are things like virtual reality and all of those kinds of things. But again, we want to always keep in mind what we need to do to get it everywhere. Technology is wonderful, but not everywhere has the same access to technology. And so we need to keep it at the right level that we can get to as many people as possible and then in these other places where we have fun things where we can do virtual reality at point some, then we can also augment it with these other technological improvements or opportunities for learning and engagement, which is great. I think again, even the computer based simulations, it takes quite a bit to get those off the ground and functioning appropriately for everyone. So that's something that we continue to work on. And then this course can also be done in mobile devices, although we like computers with bigger screens because again, they have that richness of the graphics and videos, etc. But that is available and when we think about busy clinicians and busy healthcare workers, we want to make it as accessible to them as possible. So I think that's the next big piece is really just getting it to as many people as possible.
- [27:56]
A
Thanks for that, Dr. Mottola. It's great to hear how far the ESLs program has come. The ways that you both have spoken to, some of the early wins that you've seen as a result of the program and also the work that's ahead. It seems really exciting and I can hear the passion behind both of your voices when you're speaking to this curriculum and to this approach. So I just want to thank you both again for making the time to join Beckers and tell us all about it today.
- [28:25]
C
Thank you to you and Beckers for having us. Erica, I appreciate it. It is Stroke Awareness Month here in the US So I wanted to also say it's a perfect time to be having this conversation. So thank you so much.
- [28:38]
A
Wow. It's a great call out. Thank you so much, Dr. Mottola. And thank you, Harold.
- [28:42]
B
Thank you.
- [28:43]
A
And of course, we'd also like to thank our podcast sponsor for today's episode, the American Heart Association Professional Education Hub. Listeners, be sure to tune into more podcasts from Becker's by visiting our podcast page@beckershospitalreview.com.