Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Medical Informatics and Decision Making
Published in: BMC Medical Informatics and Decision Making 1/2015

Open Access 01-12-2015 | Research article

A clinical decision support tool to screen health records for contraindications to stroke thrombolysis–a pilot study

Authors: Mu-Chien Sun, Jo-Ann Chan

Published in: BMC Medical Informatics and Decision Making | Issue 1/2015

Login to get access

Abstract

Background

The use of intravenous thrombolysis for stroke is limited by contraindications that may be difficult to identify promptly and accurately. Evidence supports the use of information technology-based clinical decision support (CDS) tools to achieve improvements in care delivery. The objective of this pilot study was to investigate the efficacy of a CDS tool to screen health records for contraindications to intravenous stroke thrombolysis.

Methods

A CDS tool was developed to rapidly screen health information in seven affiliated hospitals for contraindications to stroke thrombolysis. A fixed-sequence, 2-period crossover study was conducted to test the efficacy of the CDS tool. Four mock patient records derived from the stroke registry that contained a total of nine contraindication items in two or more of the hospitals were used for testing purposes. The test patients were preset and balanced between groups with and without the CDS tool appearing six times in each group before recruiting the participating physicians. Physicians who were responsible for thrombolytic therapy and willing to sign informed consent were recruited. The participating physicians were asked to check a list of contraindications for two of the patients by using a shared electronic medical record system among the seven hospitals with and without the CDS tool. The test time and missed contraindications were recorded and analyzed statistically.

Results

A total of 14 physicians who were responsible for stroke thrombolysis were approached, and 12 signed informed consent and took the test. By using the CDS tool, the test time was reduced significantly from 14.6 ± 7.4 to 7.3 ± 5.2 min (P = 0.010). In a total of 54 contraindications, the number of missed contraindications was reduced significantly from 23 (42.6 %) to seven (13.0 %) (P = 0.001). The difference of missed contraindication number between the two groups was statistically significant either per physician or per contraindication item.

Conclusions

By screening health records for relevant contraindications, the use of a CDS tool may reduce the time needed to review medical records and reduce the number of missed contraindications for stroke thrombolysis.
Appendix
Available only for authorised users
Literature
1.
Jones SS, Rudin RS, Perry T, Shekelle PG. Health information technology: an updated systematic review with a focus on meaningful use. Ann Intern Med. 2014;160:48–54.CrossRefPubMed
2.
Jauch EC, Saver JL, Adams Jr HP, Bruno A, Connors JJ, American Heart Association Stroke Council; Council on Cardiovascular Nursing; Council on Peripheral Vascular Disease; Council on Clinical Cardiology, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;4:870–947.CrossRef
3.
Lees KR, Bluhmki E, von Kummer R, Brott TG, Toni D, et al. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet. 2010;375:1695–703.CrossRefPubMed
4.
De Keyser J, Gdovinová Z, Uyttenboogaart M, Vroomen PC, Luijckx GJ. Intravenous alteplase for stroke: beyond the guidelines and in particular clinical situations. Stroke. 2007;38:2612–8.CrossRefPubMed
5.
Bravata DM, Kim N, Concato J, Krumholz HM, Brass LM. Thrombolysis for acute stroke in routine clinical practice. Arch Intern Med. 2002;162:1994–2001.CrossRefPubMed
6.
Lopez-Yunez AM, Bruno A, Williams LS, Yilmaz E, Zurrú C, et al. Protocol violations in community-based rTPA stroke treatment are associated with symptomatic intracerebral hemorrhage. Stroke. 2001;32:12–6.CrossRefPubMed
7.
Chen CH, Hsieh CY, Lai TB, Chuang MT, Chen WL, et al. Optimal dose for stroke thrombolysis in Asians: low dose may have similar safety and efficacy as standard dose. J Thromb Haemost. 2012;10:1270–5.CrossRefPubMed
8.
Sun MC, Lai TB, Jeng JS, Sung SF, Sung PS, et al. Safety of intravenous thrombolysis for ischaemic stroke in Asian octogenarians and nonagenarians. Age Ageing. 2015;44:158–61.CrossRefPubMed
9.
Flynn D, Ford GA, Stobbart L, Rodgers H, Murtagh MJ, et al. A review of decision support, risk communication and patient information tools for thrombolytic treatment in acute stroke: lessons for tool developers. BMC Health Serv Res. 2013. doi:10.​1186/​1472-6963-13-225.PubMedPubMedCentral
10.
Aleu A, Mellado P, Lichy C, Köhrmann M, Schellinger PD. Hemorrhagic complications after off-label thrombolysis for ischemic stroke. Stroke. 2007;38:417–22.CrossRefPubMed
11.
Lyerly MJ, Albright KC, Boehme AK, Bavarsad Shahripour R, Houston JT, et al. Safety of protocol violations in acute stroke tPA administration. J Stroke Cerebrovasc Dis. 2014;23:855–60.CrossRefPubMed
12.
13.
Chen WH, Lin HS, Chen CI, Chou MS, Liou CW, Stroke Center-CGMH/Kaohsiung, et al. The medicolegal issue of tissue plasminogen activator in ischemic stroke: a review of judiciary decrees in Taiwan. Acta Neurol Taiwan. 2011;20:163–71.PubMed
14.
Fugate JE, Rabinstein AA. Update on intravenous recombinant tissue plasminogen activator for acute ischemic stroke. Mayo Clin Proc. 2014;89:960–72.CrossRefPubMed
15.
Meretoja A, Keshtkaran M, Saver JL, Tatlisumak T, Parsons MW, et al. Stroke thrombolysis: save a minute, save a day. Stroke. 2014;45:1053–8.CrossRefPubMed
Metadata
Title
A clinical decision support tool to screen health records for contraindications to stroke thrombolysis–a pilot study
Authors
Mu-Chien Sun
Jo-Ann Chan
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Medical Informatics and Decision Making / Issue 1/2015
Electronic ISSN: 1472-6947
DOI
https://doi.org/10.1186/s12911-015-0229-4

Other articles of this Issue 1/2015

BMC Medical Informatics and Decision Making 1/2015 Go to the issue

Research article

Predicting postoperative complications of head and neck squamous cell carcinoma in elderly patients using random forest algorithm model

Research article

A qualitative evaluation of the crucial attributes of contextual Information necessary in EHR design to support patient-centered medical home care

Research article

Exploring critical factors influencing physicians’ acceptance of mobile electronic medical records based on the dual-factor model: a validation in Taiwan

Research article

Non-redundant association rules between diseases and medications: an automated method for knowledge base construction

Research article

Patient and public views about the security and privacy of Electronic Health Records (EHRs) in the UK: results from a mixed methods study

Research article

Usability evaluation and adaptation of the e-health Personal Patient Profile-Prostate decision aid for Spanish-speaking Latino men