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Implementation of a clinical pathway based on a computerized physician order entry system for ischemic stroke attenuates off-hour and weekend effects in the ED.

Authors
 Jong Min Yang  ;  Yoo Seok Park  ;  Sung Phil Chung  ;  Hyun Soo Chung  ;  Hye Sun Lee  ;  Je Sung You  ;  Shin Ho Lee  ;  Incheol Park 
Citation
 AMERICAN JOURNAL OF EMERGENCY MEDICINE, Vol.32(8) : 884-889, 2014 
Journal Title
 AMERICAN JOURNAL OF EMERGENCY MEDICINE 
ISSN
 0735-6757 
Issue Date
2014
MeSH
Administration, Intravenous ; Adult ; Aged ; Aged, 80 and over ; Critical Pathways* ; Emergency Service, Hospital/organization & administration* ; Emergency Service, Hospital/statistics & numerical data ; Female ; Fibrinolytic Agents/administration & dosage ; Fibrinolytic Agents/therapeutic use ; Hospital Mortality ; Humans ; Kaplan-Meier Estimate ; Length of Stay ; Male ; Medical Order Entry Systems* ; Middle Aged ; Patient Outcome Assessment ; Registries/statistics & numerical data ; Retrospective Studies ; Stroke/drug therapy ; Stroke/therapy* ; Time Factors ; Tissue Plasminogen Activator/administration & dosage ; Tissue Plasminogen Activator/therapeutic use ; Young Adult
Abstract
BACKGROUND: Admission on weekends and off-hours has been associated with poor outcomes and mortality from acute stroke. The purpose of this study was to investigate whether an organized clinical pathway (CP) for ischemic stroke can effectively reduce the time from arrival to evaluation and treatment in the emergency department (ED) and improve outcomes, regardless of the time from arrival in the ED. METHODS: We conducted a retrospective analysis of all consecutive patients included in the prospective registry database in the Brain Salvage through Emergency Stroke Therapy program, which uses the computerized physician order entry (CPOE) system. Patients were classified based on their time of arrival in the ED: group 1, normal working hours on weekdays; group 2, off-hours on weekdays; group 3, normal working hours on weekends; and group 4, off-hours on weekends. Clinical outcomes were categorized according to 30 days in-hospital mortality, in-hospital mortality, and the modified Rankin score during a single length of stay (LOS). RESULTS: No time intervals differed significantly among the 4 patient groups who received intravenous administration of tissue plasminogen activator (IV-tPA). Use of IV-tPA (P = .5110) was not affected by arrival in the ED on off-days or weekends. The overall mortality rate was 3.9%, and the median LOS was 7 days (Interquartile range (IQR), 5-10). By Kaplan-Meier analysis, the cumulative probability of mortality and survival did not differ significantly among the 4 groups over 30 days (P = .1557). CONCLUSION: An organized CP, based on CPOE, for ischemic stroke can effectively attenuate disparities in the time interval between ED arrival to evaluation and treatment regardless of ED arrival time. This pathway may also help to eliminate off-hour and weekend effects on outcomes from ischemic stroke.
Full Text
http://www.sciencedirect.com/science/article/pii/S0735675714003155
DOI
10.1016/j.ajem.2014.04.049
Appears in Collections:
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Emergency Medicine (응급의학교실) > 1. Journal Papers
Yonsei Authors
Park, Yoo Seok(박유석) ORCID logo https://orcid.org/0000-0003-1543-4664
Park, In Cheol(박인철) ORCID logo https://orcid.org/0000-0001-7033-766X
You, Je Sung(유제성) ORCID logo https://orcid.org/0000-0002-2074-6745
Lee, Hye Sun(이혜선) ORCID logo https://orcid.org/0000-0001-6328-6948
Chung, Sung Pil(정성필) ORCID logo https://orcid.org/0000-0002-3074-011X
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/100249
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