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0121 Sequence simulation ‘the hyper acute stroke thrombolysis pathway’
  1. Julie Combes
  1. University College London Hospitals, London, UK


Background With recommendations from the Francis Report (2013) and Berwick Report (2013) restructuring the National Health Service, considerable public and political scrutiny surrounding the health care system and its workforce has grown. As part of the restructure patient safety has been put at the heart of our organisation in an attempt to understand and analyse safety from the resilience of everyday practice.1 Hyper acute Stroke Thrombolysis Pathway may look perfect in writing but environmental and organisational elements needed for the pathway to be successful may generate barriers and complications. Utilising Interprofessional in-situ simulation we wish to analyse the pathway and detect ‘latent threats’.

Methodology In-situ simulation conducted with an actor re-creating a real clinical scenario following the Thrombolysis pathway through its entirety. Physiological variables displayed utilising iSimulate ALSi monitor, simulated props and realistic care expected by participants – including putting out a thrombolysis call, transfer of patient between departments and following protocols as per ‘normal’. The scenario was filmed at all times utilising SMOTS and GoPro camera. Three departments – Emergency Department – CT – HASU and six disciplines participated. The thrombolysis pathway was analysed with a 29 point checklist. A facilitated debrief took place after the scenario and the film footage was reviewed 2 weeks after by clinical leads. Consent was gained from all participants.

Outcomes It highlighted how the pathway could be enhanced by improving the way neuro radiologists physically communicate results from the basement scanning room; improving the pathway to include more complex assessments including stroke patients with additional health problems; and stressing the need for staff to obtain next-of-kin consent as early as possible for clinical research trials.

Potential impact Creating the opportunity for discussion and analysis, is an excellent way to recognise latent risk but also to understand the patterns in system performance.2


  1. Hollnagel E. Safety-I, Safety-II. The past and future of safety management. London: Ashgate, 2014

  2. Eurocontrol. From Safety-I to Safety-II: A White Paper. Eurocontrol 2014

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