Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
Stroke. 2010 Sep;41(9):1978-83. doi: 10.1161/STROKEAHA.110.583591. Epub 2010 Jul 22.
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.
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.
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.
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.
有效的卒中代码系统可以加快快速溶栓治疗，需要有效的通知/沟通和有组织的团队方法。我们基于计算机化医嘱录入系统（CPOE）开发了卒中代码程序，并研究了在各种医院环境中实施基于 CPOE 的程序是否有助于减少从到达急诊部（ED）到评估步骤和开始溶栓治疗的时间。
10 家医院实施了基于 CPOE 的程序。在程序实施前的 1 年和实施后的 1 年期间，比较了从到达 ED 到血液检查、计算机断层扫描和溶栓治疗的时间间隔。
实施基于 CPOE 的程序后，从 ED 到达评估步骤的时间间隔显著缩短。从 ED 到达 CT 扫描、全血细胞计数和凝血酶原时间测试的时间分别减少了 7.7 分钟、5.6 分钟和 26.8 分钟（P<0.001）。从 ED 到达静脉溶栓的时间从 71.7+/-33.6 分钟减少到 56.6+/-26.9 分钟（P<0.001）。接受溶栓治疗的患者人数从 CPOE 实施前的 3.4%（5798 例患者中的 199 例）增加到 5.8%（5405 例患者中的 312 例）（P<0.001）。CPOE 的实施还改善了发病至门时间与门至针时间之间的反比关系。
CPOE 为基础的卒中代码可以成功实施，以减少各种医院环境中溶栓治疗的院内时间延迟。CPOE 可以用作有效的工具，以促进院内通知/沟通和有组织的团队方法。
