Impact of Discharge Anticoagulation Education by Emergency Department Pharmacists at a Tertiary Academic Medical Center

Zdyb, Elizabeth G.; Courtney, D. Mark; Malik, Sanjeev; Schmidt, Michael; Lyden, Abbie

doi:10.1016/j.jemermed.2017.06.008

Cited by 18 publications

(18 citation statements)

References 10 publications

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“…Even less comprehensive methods, such as a single patient counseling session at discharge, have noted positive outcomes. Enhanced patient understanding of warfarin has resulted in better INR control and decreased hospital readmission rates [ 17 , 18 , 19 ]. In one study, patients who did not receive pharmacist education in the hospital prior to discharge required more interventions related to adherence concerns, incorrect administration, and continued use of interacting drugs versus those who did (36.4% vs. 12.9%, p = 0.0005).…”

Section: Anticoagulation Management Servicesmentioning

confidence: 99%

“…In one study, patients who did not receive pharmacist education in the hospital prior to discharge required more interventions related to adherence concerns, incorrect administration, and continued use of interacting drugs versus those who did (36.4% vs. 12.9%, p = 0.0005). In the same population, patients who had not received pharmacist counseling had higher readmission rates and ED visits due to anticoagulation problems within 3 months of discharge (12.12% vs. 1.85%, p = 0.0069) [ 19 ]. In the inpatient setting, patient education resulted in significantly reduced interacting medications, extreme INRs, and adverse events during warfarin therapy [ 20 ].…”

Section: Anticoagulation Management Servicesmentioning

confidence: 99%

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Patient Education on Oral Anticoagulation

Hawes

2018

Pharmacy

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Given the potential harm associated with anticoagulant use, patient education is often provided as a standard of care and emphasized across healthcare settings. Effective anticoagulation education involves face-to-face interaction with a trained professional who ensures that the patient understands the risks involved, the precautions that should be taken, and the need for regular monitoring. The teaching should be tailored to each patient, accompanied with written resources and utilize the teach-back method. It can be incorporated in a variety of pharmacy practice settings, including in ambulatory care clinics, hospitals, and community pharmacies.

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Section: Anticoagulation Management Servicesmentioning

confidence: 99%

Section: Anticoagulation Management Servicesmentioning

confidence: 99%

Patient Education on Oral Anticoagulation

Hawes

2018

Pharmacy

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“…This system addressed potential problems before a serious complication arose, identified complications early, and ensured patients had appropriate follow-up, lab work, and home health services. Vascular surgery patients are commonly discharged on new medications that are associated with increased rates of readmission (e.g., anticoagulants, antiplatelet agents, antibiotics) and have high rates of wound complications, that are commonly managed by negative pressure therapy or complex and frequent dressing changes [18]. An intervention that ensures patients are comfortable with their discharge care, do not have lingering questions, and can be seen if needed in a prompt fashion facilitated early discharge from the hospital.…”

Section: Discussionmentioning

confidence: 99%

Reduced length of stay and 30-day readmission rate on an inpatient vascular surgery service

Aicher

Hanlon

Rosenberger

et al. 2019

Journal of Vascular Nursing

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Background: As the cost of care for patients with specific diagnoses becomes fixed, hospitals must develop systems to reduce length of stay and optimize the utilization of hospital resources while maintaining a high quality of care. The goal of this study is to evaluate the implementation and efficacy of a system designed to reduce average length of stay on a vascular surgery service. Study Design: To effectively reduce our average length of stay we restructured patient rounds, implemented multidisciplinary rounds, introduced clinical pathways to post-operative care, and expanded outpatient management of post-operative patients. 1697 adult vascular surgery patients discharged while under the medical direction of a vascular surgeon between 7/1/2013 and 6/30/2016 were included in the study. Results: Improving communication with critical staff and utilizing procedural space outside of the main operating rooms led to a 2.8-day reduction in length of stay (10.8 vs 8.0, P < 0.001). There was a trend toward a reduction in 30-day readmission rate (12% vs. 10%, respectively; P = 0.01) and no significant difference in case-mix index as a measure of illness severity (2.5 vs. 2.4, respectively; P = 0.15). Length of stay reductions were heterogeneous among the types of vascular disease studied, with greater improvements seen in patients undergoing lower extremity amputation, lower extremity angiogram, and endovascular aneurysm repair for non-ruptured abdominal aortic aneurysm. Less pronounced differences were observed in patients undergoing carotid artery endarterectomy/stenting and lower extremity bypasses. Conclusions: Restructuring team rounds and instituting a multidisciplinary approach to discharge planning produced significant reductions in length of stay without a deleterious effect on patient care that may impact hospital profitability.

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“…37 Patient education, including the ability to receive and understand their anticoagulation therapy at hospital discharge, has been associated with decreased readmission related to the anticoagulation therapy and lower rate of issues related to nonadherence. 38 Due to the need for laboratory measurement, patients using warfarin have many potential contact points with providers offering opportunities for education in the ambulatory setting. Patients prescribed DOACs, however, benefit from the more predictable dose effect and thus freedom from the burden of frequent laboratory measurement, but this may be a disadvantage in that less clinical oversight may result in fewer educational moments.…”

Section: Ep 6 ( Patient Education)mentioning

confidence: 99%