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

Authors
Heo, JH; Kim, YD; Nam, HS; Hong, KS; Ahn, SH; Cho, HJ; Choi, HY; Han, SW; Cha, MJ; Hong, JM; Kim, GM; Kim, GS; Kim, HJ; Kim, SH; Kim, YJ; Kwon, SU; Lee, BC; Lee, JH; Lee, KH; Oh, MS
Citation
Stroke, 41(9):1978-1983, 2010
Journal Title
Stroke
ISSN
0039-24991524-4628
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.
MeSH terms
Blood Cell CountEmergency Service, HospitalFemaleFibrinolytic Agents/therapeutic useHumansMaleMedical Order Entry Systems*Outcome Assessment (Health Care)Prospective StudiesProthrombin TimeRegression AnalysisStroke/drug therapy*Thrombolytic Therapy/methods*Time FactorsTriage
DOI
10.1161/STROKEAHA.110.583591
PMID
20651269
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Journal Papers > School of Medicine / Graduate School of Medicine > Neurology
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