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A computerized in-hospital alert system for thrombolysis in acute stroke

Authors
 Ji Hoe Heo  ;  Young Dae Kim  ;  Hyo Suk Nam  ;  Keun-sik Hong  ;  Seong Hwan Ahn  ;  Hyun Ji Cho  ;  Hye-Yeon Choi  ;  Sang Won Han  ;  Myoung-Jin Cha  ;  Ji Man Hong  ;  Gyeong-Moon Kim  ;  Gyu Sik Kim  ;  Hye Jin Kim  ;  Seo Hyun Kim  ;  Yong-Jae Kim  ;  Sun Uck Kwon  ;  Byung-Chul Lee  ;  Jun Hong Lee  ;  Kwang Ho Lee  ;  Mi Sun Oh 
Citation
 Stroke, Vol.41(9) : 1978-1983, 2010 
Journal Title
 Stroke 
ISSN
 0039-2499 
Issue Date
2010
MeSH
Blood Cell Count ; Emergency Service, Hospital ; Female ; Fibrinolytic Agents/therapeutic use ; Humans ; Male ; Medical Order Entry Systems* ; Outcome Assessment (Health Care) ; Prospective Studies ; Prothrombin Time ; Regression Analysis ; Stroke/drug therapy* ; Thrombolytic Therapy/methods* ; Time Factors ; Triage
Keywords
acute stroke ; computerized physician order entry ; stroke ; thrombolysis
Abstract
BACKGROUND AND PURPOSE: An effective stroke code system that can expedite rapid thrombolytic treatment requires effective notification/communication and an organized team approach. We developed a stroke code program based on the computerized physician order entry (CPOE) system and investigated whether implementation of this CPOE-based program is useful for reducing the time from arrival at emergency departments (ED) to evaluation steps and the initiation of thrombolytic treatment in various hospital settings. METHODS: The CPOE-based program was implemented by 10 hospitals. Time intervals from arrival at the ED to blood tests, computed tomography scanning, and thrombolytic treatment during the 1-year period before and the 1-year period after the program implementation were compared. RESULTS: Time intervals from ED arrival to evaluation steps were significantly reduced after implementation of the CPOE-based program. Times from ED arrival to CT scan, complete blood counts, and prothrombin time testing were reduced by 7.7 minutes, 5.6 minutes, and 26.8 minutes, respectively (P<0.001). The time from ED arrival to intravenous thrombolysis was reduced from 71.7+/-33.6 minutes to 56.6+/-26.9 minutes (P<0.001). The number of patients who were treated with thrombolysis increased from 3.4% (199/5798 patients) before the CPOE-based program to 5.8% (312/5405 patients) afterward (P<0.001). The CPOE implementation also improved the inverse relationship between onset-to-door time and door-to-needle time. CONCLUSIONS: The CPOE-based stroke code could be successfully implemented to reduce in-hospital time delay in thrombolytic therapy in various hospital settings. CPOE may be used as an efficient tool to facilitate in-hospital notification/communication and an organized team approach
Files in This Item:
T201002416.pdf Download
DOI
10.1161/STROKEAHA.110.583591
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Young Dae(김영대) ORCID logo https://orcid.org/0000-0001-5750-2616
Nam, Hyo Suk(남효석) ORCID logo https://orcid.org/0000-0002-4415-3995
Cho, Hyun Ji(조현지)
Cha, Myoung Jin(차명진)
Choi, Hye Yoen(최혜연)
Heo, Ji Hoe(허지회) ORCID logo https://orcid.org/0000-0001-9898-3321
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/101567
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