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Updated: Mar 23, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Comprehensive code stroke program to reduce reperfusion delay for in-hospital stroke patients
Joonsang Yoo1, Dongbeom Song1, Jang-Hyun Baek1
1Department of Neurology, Severance Stroke Center, Yonsei University College of Medicine, Seoul, Korea.
Insights
A code stroke program significantly reduced treatment times for in-hospital stroke patients. This initiative improved evaluation and reperfusion therapy, leading to faster interventions for stroke care.
Area of Science:
- Neurology
- Hospital Administration
- Public Health
Background:
- In-hospital stroke occurs during hospital admission, and timely treatment is crucial.
- Patients with in-hospital stroke are candidates for reperfusion therapy but often face treatment delays.
- Rapid intervention is essential to improve outcomes for stroke patients.
Purpose of the Study:
- To evaluate the effectiveness of a code stroke program in reducing treatment times for in-hospital stroke.
- To assess the impact of a program involving computerized physician order entry, specific protocols, and staff education.
- To compare treatment intervals before and after program implementation.
Main Methods:
- Implementation of a code stroke program in cardiology and cardiovascular surgery departments.
- Utilized computerized physician order entry, specific evaluation/treatment protocols, and staff education.
- Compared time intervals (onset to evaluation/reperfusion) pre- and post-program in target vs. other wards.
Main Results:
- Significant reductions in time from symptom onset to neurology notification (50 vs. 28 min) and brain imaging (91 vs. 41 min).
- Decreased time from symptom recognition to notification (22 vs. 9 min).
- Substantial reductions in time to intravenous tissue plasminogen activator (tPA) administration (120 vs. 65 min) and arterial puncture (295 vs. 165 min).
Conclusions:
- A comprehensive code stroke program, including computerized physician order entry, effectively reduces evaluation and reperfusion times for in-hospital stroke.
- The program demonstrated significant improvements in treatment timeliness within targeted hospital departments.
- The findings support the adoption of such programs to enhance stroke care efficiency.
Background:
Stroke may occur during hospital admission (in-hospital stroke). Although patients with in-hospital stroke are potentially good candidates for reperfusion therapy, they often do not receive treatment as rapidly as expected.
Aims:
We investigated the effect of a code stroke program for in-hospital stroke, which included the use of computerized physician order entry, specific evaluation and treatment protocols for in-hospital stroke patients, and regular education of medical staffs.
Methods:
We implemented the program in the cardiology and cardiovascular surgery departments/wards (target-ward group) in November 2008. We compared time intervals from symptom onset to evaluation and reperfusion treatment before and after program implementation between the target-ward and other departments/wards (other-ward group).
Results:
Among 70 consecutive in-hospital stroke patients who received reperfusion therapy between July 2002 and February 2015, 28 and 42 were treated before and after program implementation, respectively. After program implementation, time intervals from symptom onset to neurology notification (50 min vs. 28 min; P = 0.033), symptom onset to brain imaging (91 min vs. 41 min; P < 0.001), and symptom recognition to notification (22 min vs. 9 min; P = 0.011) were reduced in the target-ward group. Finally, times from symptom onset to intravenous tissue plasminogen activator administration and to arterial puncture were reduced by 55 min (120 min vs. 65 min; P < 0.001) and 130 min (295 min vs. 165 min; P < 0.001), respectively. However, time reductions in the other-ward group were not significant.
Conclusions:
The comprehensive program for in-hospital stroke that included the use of computerized physician order entry was effective in reducing time intervals to evaluation and reperfusion therapy.
