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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.

DC Field Value Language
dc.contributor.author박유석-
dc.contributor.author박인철-
dc.contributor.author유제성-
dc.contributor.author이혜선-
dc.contributor.author정성필-
dc.contributor.author정현수-
dc.date.accessioned2015-01-06T17:34:58Z-
dc.date.available2015-01-06T17:34:58Z-
dc.date.issued2014-
dc.identifier.issn0735-6757-
dc.identifier.urihttps://ir.ymlib.yonsei.ac.kr/handle/22282913/100249-
dc.description.abstractBACKGROUND: 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.-
dc.description.statementOfResponsibilityopen-
dc.format.extent884~889-
dc.relation.isPartOfAMERICAN JOURNAL OF EMERGENCY MEDICINE-
dc.rightsCC BY-NC-ND 2.0 KR-
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/2.0/kr/-
dc.subject.MESHAdministration, Intravenous-
dc.subject.MESHAdult-
dc.subject.MESHAged-
dc.subject.MESHAged, 80 and over-
dc.subject.MESHCritical Pathways*-
dc.subject.MESHEmergency Service, Hospital/organization & administration*-
dc.subject.MESHEmergency Service, Hospital/statistics & numerical data-
dc.subject.MESHFemale-
dc.subject.MESHFibrinolytic Agents/administration & dosage-
dc.subject.MESHFibrinolytic Agents/therapeutic use-
dc.subject.MESHHospital Mortality-
dc.subject.MESHHumans-
dc.subject.MESHKaplan-Meier Estimate-
dc.subject.MESHLength of Stay-
dc.subject.MESHMale-
dc.subject.MESHMedical Order Entry Systems*-
dc.subject.MESHMiddle Aged-
dc.subject.MESHPatient Outcome Assessment-
dc.subject.MESHRegistries/statistics & numerical data-
dc.subject.MESHRetrospective Studies-
dc.subject.MESHStroke/drug therapy-
dc.subject.MESHStroke/therapy*-
dc.subject.MESHTime Factors-
dc.subject.MESHTissue Plasminogen Activator/administration & dosage-
dc.subject.MESHTissue Plasminogen Activator/therapeutic use-
dc.subject.MESHYoung Adult-
dc.titleImplementation of a clinical pathway based on a computerized physician order entry system for ischemic stroke attenuates off-hour and weekend effects in the ED.-
dc.typeArticle-
dc.contributor.collegeCollege of Medicine (의과대학)-
dc.contributor.departmentYonsei Biomedical Research Center (연세의생명연구원)-
dc.contributor.googleauthorJong Min Yang-
dc.contributor.googleauthorYoo Seok Park-
dc.contributor.googleauthorSung Phil Chung-
dc.contributor.googleauthorHyun Soo Chung-
dc.contributor.googleauthorHye Sun Lee-
dc.contributor.googleauthorJe Sung You-
dc.contributor.googleauthorShin Ho Lee-
dc.contributor.googleauthorIncheol Park-
dc.identifier.doi10.1016/j.ajem.2014.04.049-
dc.admin.authorfalse-
dc.admin.mappingfalse-
dc.contributor.localIdA01592-
dc.contributor.localIdA01628-
dc.contributor.localIdA02507-
dc.contributor.localIdA03625-
dc.contributor.localIdA03312-
dc.relation.journalcodeJ00079-
dc.identifier.eissn1532-8171-
dc.identifier.pmid24928408-
dc.identifier.urlhttp://www.sciencedirect.com/science/article/pii/S0735675714003155-
dc.contributor.alternativeNamePark, Yoo Seok-
dc.contributor.alternativeNamePark, In Cheol-
dc.contributor.alternativeNameYou, Je Sung-
dc.contributor.alternativeNameLee, Hye Sun-
dc.contributor.alternativeNameChung, Sung Pil-
dc.contributor.alternativeNameChung, Hyun Soo-
dc.contributor.affiliatedAuthorPark, Yoo Seok-
dc.contributor.affiliatedAuthorPark, In Cheol-
dc.contributor.affiliatedAuthorYou, Je Sung-
dc.contributor.affiliatedAuthorChung, Sung Pil-
dc.contributor.affiliatedAuthorLee, Hye Sun-
dc.rights.accessRightsfree-
dc.citation.volume32-
dc.citation.number8-
dc.citation.startPage884-
dc.citation.endPage889-
dc.identifier.bibliographicCitationAMERICAN JOURNAL OF EMERGENCY MEDICINE, Vol.32(8) : 884-889, 2014-
dc.identifier.rimsid51773-
dc.type.rimsART-
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Emergency Medicine (응급의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers

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