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Decision-making support using a standardized script and visual decision aid to reduce door-to-needle time in stroke
DC Field | Value | Language |
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dc.contributor.author | 김은혜 | - |
dc.date.accessioned | 2019-06-17T00:32:35Z | - |
dc.date.available | 2019-06-17T00:32:35Z | - |
dc.date.issued | 2017 | - |
dc.identifier.uri | https://ir.ymlib.yonsei.ac.kr/handle/22282913/169681 | - |
dc.description.abstract | Background and Purpose: Rapid administration of intravenous recombinant tissue plasminogen activator (IV tPA) is an effective way to enhance thrombolytic efficacy in stroke patients. The process of decision-making by patients or their families may cause a delay in treatment. We investigated how a protocol using decision-making support (DMS) for patients and their families could reduce door-to-needle time in acute stroke. Methods: We implemented a DMS protocol using a standardized script and visual decision aid for explanations to patients and their families. Reasons for delay were identified in cases with door-to-needle time >40 min. We compared door-to-needle time and reasons for treatment delay before (January 2007 to December 2009) and after (January 2010 to December 2012) implementation of the DMS protocol. 2 Results: After the implementation of DMS protocol, median door-to-needle time was reduced from 46 min to 40 min (p=0.001). The proportion of patients with door-to-needle time ≤ 40 min was greater after the implementation (64/118 [54.2%] vs. 40/111 [36.0%], p=0.006). The proportion of cases with delay due to waiting for informed consent was significantly reduced from 32.4 % to 14.8% (p=0.024). Multivariable logistic regression analysis showed that the implementation of the DMS protocol was independently associated with door to-needle time ≤40 min (adjusted odds ratio 2.13, 95% confidence interval 1.23 3.67). Conclusion: Decision making support for the patient or family’s decision using standardized scripts and visual aids was helpful in reducing door-to-needle time. More widespread implementation of this approach is warranted because it is simpleand can be easily implemented. | - |
dc.description.statementOfResponsibility | open | - |
dc.format | application/pdf | - |
dc.publisher | Graduate School, Yonsei University | - |
dc.rights | CC BY-NC-ND 2.0 KR | - |
dc.rights | https://creativecommons.org/licenses/by-nc-nd/2.0/kr/ | - |
dc.title | Decision-making support using a standardized script and visual decision aid to reduce door-to-needle time in stroke | - |
dc.title.alternative | 급성뇌졸중 혈전용해치료의 병원 내 시간지연을 줄이기 위한 표준 설명문 및 그림 도표의 사용 | - |
dc.type | Thesis | - |
dc.contributor.college | College of Medicine (의과대학) | - |
dc.contributor.department | Dept. of Neurology (신경과학교실) | - |
dc.contributor.department | Dept. of Neurology (신경과학교실) | - |
dc.contributor.localId | A00828 | - |
dc.subject.keyword | stroke | - |
dc.subject.keyword | thrombolysis | - |
dc.subject.keyword | clinical decision support | - |
dc.subject.keyword | time-totreatment | - |
dc.subject.keyword | quality improvement | - |
dc.description.degree | 박사 | - |
dc.contributor.alternativeName | Kim, Eun Hye | - |
dc.contributor.affiliatedAuthor | 김은혜 | - |
dc.type.local | Dissertation | - |
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