Abstract T MP88: Computerized In-hospital Alert System Reduces Time Delay to Reperfusion Therapy for In-hospital Stroke Patients
Introduction: Stroke may occur while patients are being admitted (in-hospital stroke [IHS]). Although patients with IHS are potentially good candidates for fast reperfusion therapy, many patients are often not treated rapidly as are expected.
Hypothesis: A code stroke program using computerized physician order entry (CPOE) will be effective in reducing time delay to reperfusion therapy in patients with IHS.
Methods: We developed a code stroke program for IHS, based on CPOE. The program included protocols for stroke recognition, activation and notification, imaging, preparation of tissue-type plasminogen activator (tPA), and regular education of medical staffs. We implemented this program for cardiology and cardiovascular surgery wards because in our previous study, about one-half of all IHS occurred in them. We compared time intervals from symptom onset to evaluations and reperfusion treatment before and after the program implementation in patients with IHS that developed inside or outside the program.
Results: The program launched at November 2008. All consecutive patients who received reperfusion therapy due to IHS that developed outside the neurology department from July 2002 to June 2014 were included for this study. Among total 59 IHS patients enrolled, 20 patients were treated before and 39 patients after implementation of the program (24 patients inside the program [cardiology/cardiovascular surgery wards], 15 patients outside the program). In cases treated inside the program, time intervals from symptom onset to brain image (98.5 min vs 37 min; P<0.001), symptom recognition to neurology notification (29.5 min vs 15 min; P=0.008), and symptom onset to IV tPA (130 min vs 65 min; P<0.001) or to arterial puncture (270 min vs 165 min; P<0.001) were reduced significantly after the program implementation. However, in cases treated outside the program. time intervals from symptom onset to evaluation, notification, and IV tPA, except symptom onset to arterial puncture (270 vs 207.5 min, P=0.025), were not reduced.
Conclusions: The computerized in-hospital alert system, which was developed for IHS, was effective to reduce time delay to evaluation and reperfusion treatment. More widespread implementation of the program for patients with IHS is warranted.
Author Disclosures: J. Yoo: None. D. Song: None. K. Lee: None. Y. Kim: None. J. Yang: None. Y. Jung: None. H. Cho: None. H. Nam: None. J. Heo: None.
- © 2015 by American Heart Association, Inc.