Unveiling team needs: a qualitative study of simulation training for endovascular cerebral thrombectomy

Effective multidisciplinary teamwork is crucial for successful endovascular thrombectomy (EVT) treatment, a critical stroke intervention classified as a non-operating room anaesthesia (NORA) procedure. Our hospital incorporated EVT training into regular stroke simulation training. This study aimed to investigate team members' experiences of simulation training in preparation for clinical EVT, including how the training and related clinical procedures could be improved to address their identified needs.

Six focus group interviews (one anaesthesia-only professional, five mixed healthcare professionals) were conducted with a purposeful sample of EVT team members. The data were analysed using inductive qualitative content analysis.

EVT team members considered simulation training an essential introduction to the clinical procedure, particularly for familiarisation with the angio suite, equipment, team roles and communication. However, they reported that the simulation did not prepare them for challenges inherent to NORA procedures encountered during clinical EVT. These included managing multidisciplinary task interactions, maintaining haemodynamic and respiratory stability, and working within spatial and access constraints. Consequently, the experience of disorganised teamwork persisted in clinical EVT. The team members reported a lack of shared understanding of roles, responsibilities and communication expectations, particularly between anaesthesia professionals and other team members. This contributed to unfamiliarity with team dynamics and workflow. The clinical EVT team leader inconsistently facilitated collaboration, impacting team communication and effectiveness. The participants proposed modifications to the simulation training and clinical procedure to address these issues.

Our study highlights the need to incorporate the multidisciplinary challenges of NORA procedures into EVT simulation training, emphasising active input from all professional groups involved in the EVT team, particularly anaesthesia. Practical recommendations for planning and implementing such simulation training are proposed.