title: A computerized in-hospital alert system for thrombolysis in acute stroke.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Neurology, Yonsei University College of Medicine, Seoul, Korea. jhheo@yuhs.ac
authors.forename: Ji Hoe
authors.initials: JH
authors.lastname: Heo
authors.forename: Young Dae
authors.initials: YD
authors.lastname: Kim
authors.forename: Hyo Suk
authors.initials: HS
authors.lastname: Nam
authors.forename: Keun-Sik
authors.initials: KS
authors.lastname: Hong
authors.forename: Seong Hwan
authors.initials: SH
authors.lastname: Ahn
authors.forename: Hyun Ji
authors.initials: HJ
authors.lastname: Cho
authors.forename: Hye-Yeon
authors.initials: HY
authors.lastname: Choi
authors.forename: Sang Won
authors.initials: SW
authors.lastname: Han
authors.forename: Myoung-Jin
authors.initials: MJ
authors.lastname: Cha
authors.forename: Ji Man
authors.initials: JM
authors.lastname: Hong
authors.forename: Gyeong-Moon
authors.initials: GM
authors.lastname: Kim
authors.forename: Gyu Sik
authors.initials: GS
authors.lastname: Kim
authors.forename: Hye Jin
authors.initials: HJ
authors.lastname: Kim
authors.forename: Seo Hyun
authors.initials: SH
authors.lastname: Kim
authors.forename: Yong-Jae
authors.initials: YJ
authors.lastname: Kim
authors.forename: Sun Uck
authors.initials: SU
authors.lastname: Kwon
authors.forename: Byung-Chul
authors.initials: BC
authors.lastname: Lee
authors.forename: Jun Hong
authors.initials: JH
authors.lastname: Lee
authors.forename: Kwang Ho
authors.initials: KH
authors.lastname: Lee
authors.forename: Mi Sun
authors.initials: MS
authors.lastname: Oh
mesh_terms: D001772:Blood Cell Count; D004636:Emergency Service, Hospital; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011517:Prothrombin Time; D012044:Regression Analysis; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D014218:Triage
chemical_list: D005343:Fibrinolytic Agents