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Computerized Clinical Decision Support System Improves Door-to-Needle Time for Acute Ischemic StrokeA1

Computerized Clinical Decision Support System Improves Door-to-Needle Time for Acute Ischemic StrokeA1

Background

Administration of thrombolytics (tPA) within the first 60 minutes of presentation for acute Ischemic Stroke is recommended. We utilized a computerized clinical decision support (CCDS) software to identify such patients and created timely alerts to coordinate teams and optimize workflow through a plan-do-study-act (PDSA) based approach.

Methods

We reviewed all patients who received thrombolytics for Ischemic Stroke after prospectively implementing the DECISIOInsight software which digitized our institutional stroke protocol in patients with acute Ischemic Stroke. The software displayed a countdown door-to-needle (DTN) timer at bedside while sending out automated alerts via TigerConnect (a HIPAA compliant communication tool) every 15 minutes to key patient care providers. We performed PDSA cycles to address systemic issues affecting the delay of care in real time using this CCDS software and workflow modification tool. The primary outcome was DTN time. The secondary outcome was DTN <30 or <45 minutes.

Results

76 patients (46% females, 50% African American, average age of 67 years, median NIHSS of 7.5 and ASPECTS score of 10) received tPA between January 2020 and November 2021. The average time to tPA decreased from 84 minutes (1st Quarter 2020) to 39 minutes (3rd Quarter 2021) (p for trend =0.01). Similarly, the proportion of patients receiving tPA within 45 minutes and within 30 minutes improved from 27.3% to 83.3% (p for trend =0.01) and 0.0% to 41.7% (p for trend =0.006), respectively.

Conclusions

Despite the COVID-19 pandemic, the CCDS-based stroke identification and alerting system significantly improved DTN time in ischemic stroke patients.

Abstract Title:

Computerized Clinical Decision Support System Improves Door-to-Needle Time for Acute Ischemic StrokeA1

Authors:

Venkatasubba Rao, C.; Villatoro, E.; Nguyen, V.; Siddiqui, K.; Ahmad, A.; McGlennon, M.; Hirzallah, M.; Ressler, K.; Hafeez, U.; Damani, R.; Radhakrishnan, H.; Holcomb, J.; Shresta, B.; Bershad, E..

Presented By:

European Stroke Journal




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