A computerized in-hospital alert system for thrombolysis in acute stroke.
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.
Heo
Ji Hoe
JH
Department of Neurology, Yonsei University College of Medicine, Seoul, Korea. jhheo@yuhs.ac
Kim
Young Dae
YD
Nam
Hyo Suk
HS
Hong
Keun-Sik
KS
Ahn
Seong Hwan
SH
Cho
Hyun Ji
HJ
Choi
Hye-Yeon
HY
Han
Sang Won
SW
Cha
Myoung-Jin
MJ
Hong
Ji Man
JM
Kim
Gyeong-Moon
GM
Kim
Gyu Sik
GS
Kim
Hye Jin
HJ
Kim
Seo Hyun
SH
Kim
Yong-Jae
YJ
Kwon
Sun Uck
SU
Lee
Byung-Chul
BC
Lee
Jun Hong
JH
Lee
Kwang Ho
KH
Oh
Mi Sun
MS
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
D005343:Fibrinolytic Agents