• Ji Hoe Heo, Young Dae Kim, Hyo Suk Nam, Keun-Sik Hong, Seong Hwan Ahn, Hyun Ji Cho, Hye-Yeon Choi, Sang Won Han, Myoung-Jin Cha, Ji Man Hong, Gyeong-Moon Kim, Gyu Sik Kim, Hye Jin Kim, Seo Hyun Kim, Yong-Jae Kim, Sun Uck Kwon, Byung-Chul Lee, Jun Hong Lee, Kwang Ho Lee, and Mi Sun Oh.
• Department of Neurology, Yonsei University College of Medicine, Seoul, Korea. jhheo@yuhs.ac
• Stroke. 2010 Sep 1;41(9):1978-83.

Background And PurposeAn 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.MethodsThe 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.ResultsTime 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.ConclusionsThe 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.

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