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Comprehensive code stroke program to reduce reperfusion delay for in-hospital stroke patients

 Joonsang Yoo  ;  Dongbeom Song  ;  Jang-Hyun Baek  ;  Kijeong Lee  ;  Yohan Jung  ;  Han-Jin Cho  ;  Jae Hoon Yang  ;  Hyun Ji Cho  ;  Hye-Yeon Choi  ;  Young Dae Kim  ;  Hyo Suk Nam  ;  Ji Hoe Heo 
 International Journal of Stroke, Vol.11(6) : 656-662, 2016 
Journal Title
 International Journal of Stroke 
Issue Date
Administration, Intravesical ; Aged ; Female ; Fibrinolytic Agents/therapeutic use ; Hospitalization* ; Humans ; Inpatients ; Male ; Middle Aged ; Reperfusion* ; Stroke/classification* ; Stroke/diagnostic imaging ; Stroke/therapy* ; Time Factors ; Time-to-Treatment ; Tissue Plasminogen Activator/therapeutic use ; Treatment Outcome
Stroke ; computerized physician order entry ; in-hospital stroke ; quality improvement ; reperfusion ; thrombolysis
BACKGROUND: Stroke may occur during hospital admission (in-hospital stroke). Although patients with in-hospital stroke are potentially good candidates for reperfusion therapy, they often do not receive treatment as rapidly as expected. AIMS: We investigated the effect of a code stroke program for in-hospital stroke, which included the use of computerized physician order entry, specific evaluation and treatment protocols for in-hospital stroke patients, and regular education of medical staffs. METHODS: We implemented the program in the cardiology and cardiovascular surgery departments/wards (target-ward group) in November 2008. We compared time intervals from symptom onset to evaluation and reperfusion treatment before and after program implementation between the target-ward and other departments/wards (other-ward group). RESULTS: Among 70 consecutive in-hospital stroke patients who received reperfusion therapy between July 2002 and February 2015, 28 and 42 were treated before and after program implementation, respectively. After program implementation, time intervals from symptom onset to neurology notification (50?min vs. 28?min; P?=?0.033), symptom onset to brain imaging (91?min vs. 41?min; P?<?0.001), and symptom recognition to notification (22?min vs. 9?min; P?=?0.011) were reduced in the target-ward group. Finally, times from symptom onset to intravenous tissue plasminogen activator administration and to arterial puncture were reduced by 55?min (120?min vs. 65?min; P?<?0.001) and 130?min (295?min vs. 165?min; P?<?0.001), respectively. However, time reductions in the other-ward group were not significant. CONCLUSIONS: The comprehensive program for in-hospital stroke that included the use of computerized physician order entry was effective in reducing time intervals to evaluation and reperfusion therapy.
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1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 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
Baek, Jang Hyun(백장현)
Song, Dong Beom(송동범)
Yang, Jae Hoon(양재훈)
Yoo, Joon Sang(유준상)
Lee, Ki Jeong(이기정)
Jung, Yo Han(정요한)
Cho, Han Jin(조한진)
Cho, Hyun Ji(조현지)
Choi, Hye Yoen(최혜연)
Heo, Ji Hoe(허지회) ORCID logo https://orcid.org/0000-0001-9898-3321
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