Abstract Body: Background: Acute stroke management requires rapid triage and a highly efficient team to work together for prompt diagnosis and acute reperfusion therapy. An emerging practice is incorporating Advanced Practice Providers (APPs) into the stroke response teams, a model that has been shown to be successful in delivering thrombolytic therapy to patients with ST elevation MI as well. Simulation-based training has been shown to be a beneficial part of education for neurology residents and APPs. Emergency Department APPs have limited experience with Stroke Code training which leads to lack of provider confidence and could presumably be a factor contributing to suboptimal triage and stroke management in the emergency room setting.

Hypothesis: Simulation-based training would improve confidence, comfort level and preparedness in emergency department APPs for acute management during stroke codes.

Methods: A prospective quasi-experimental pre-test/post-test study was conducted. Participants included 13 emergency department advanced practice providers at a Comprehensive Stroke Center, including advanced practice nurses (APRNs) and physician assistants (PAs) who attended a case-based acute stroke simulation session involving 6 cases supervised by a vascular neurologist and APP followed by a debriefing session. Questionnaire included items on comfort and confidence surrounding clinical evaluation and acute reperfusion therapy in stroke management. Responses were analyzed using the Mann-Whitney U test.

Results: On a 5-point Likert scale, median score for participant comfort in leading a Stroke Code increased from 3 (neutral) to 4 (agree) (p ≤ 0.008). Median score also increased from 3 to 4 in respect to feeling prepared for their next stroke code and 2 to 4 in comfort assessing for Large Vessel Occlusion (p ≤ 0.008) and administering IV Thrombolysis (P<0.001).

Conclusion: There was notable improvement in knowledge and comfort surround stroke code management among advanced practice providers based on simulation training. Stroke code simulation training can be a valuable modality in improving skill and comfort for advanced practice providers practicing in the emergency department setting; and simulation-based training can be expanded to enhance training and improve stroke management involving additional team members. Further research is needed to determine impact of simulation training on treatment times and outcomes of acute stroke patients.