Implementation of a Novel Algorithm to Decrease Unnecessary Hospitalizations in Patients Presenting to a Community Emergency Department With Atrial Fibrillation

DeMeester, Susanne; Hess, Rebecca A.; Hubbard, Bradley; LeClerc, Kara; Ferraro, Jane; Albright, Jeremy J.

doi:10.1111/acem.13383

Cited by 6 publications

(1 citation statement)

References 18 publications

(23 reference statements)

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“…Real-time telemetry was the next evolution followed by implantable loop recorders and, most recently, smartphone technology. Improvements in technology have increased the utilization of mobile devices to deliver care at a distance; it has also shown to be an effective intervention to decrease anxiety and unnecessary hospitalizations and visits to EDs and UCs ( Demeester et al, 2018 ). Successful applications thereof to cardiac conditions in general—and AF in particular—have improved care, reduced symptomatology, and improved the quality of life.…”

Section: Introductionmentioning

confidence: 99%

Improving care for patients with atrial fibrillation through the use of a personal electrocardiogram

Praus

Li²,

Barbarash³

et al. 2021

J Am Assoc Nurse Pract

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Background: Atrial fibrillation (AF) is the most common arrhythmia affecting more than six million people in the United States. The economic burden is estimated to be >$6 billion annually with catastrophic events dramatically increasing expenditure. When patients experience symptoms, they commonly present to an acute care facility; this can be costly and anxiety provoking. Local problem: Same-day access issues prohibit patients from communicating directly with their cardiology provider, forcing them to use resources and increasing psychological burden. Methods: A convenience sample, made up of 43 patients, was given a KardiaMobile device. Eligible patients had ≥2 AF-related emergency department (ED) or urgent care (UC) visits over 12 months, needed rate control with medication titration, or were monitored for AF reoccurrence after reestablishing sinus rhythm. Interventions: Patients emailed recordings daily and when experiencing symptoms. The recordings were reviewed by a nurse practitioner (NP); abnormal readings were followed by a phone call, telehealth, or in-person visit. Results: An independently designed survey was conducted online; almost all respondents (97%) found value in the project and the device. Virtually all respondents (97%) felt that the program improved access. A majority (86%) reported decreased anxiety. Had the respondents not been in the program, 34% indicated that they would have presented to an ED and 25% would have presented to an UC, realizing a cost savings of $81,950 in reduced ED visits alone. Conclusion: A personal electrocardiogram, with NP oversight, to manage AF is cost-effective and reduces unnecessary resource utilization. It is patient centered, improves access, and empowers patients to manage their symptoms.

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Section: Introductionmentioning

confidence: 99%

Improving care for patients with atrial fibrillation through the use of a personal electrocardiogram

Praus

Li²,

Barbarash³

et al. 2021

J Am Assoc Nurse Pract

View full text Add to dashboard Cite

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Interventions to Improve Emergency Department–Related Transitions in Care for Adult Patients With Atrial Fibrillation and Flutter

Gilbertson

Moghrabi

Kirkland

et al. 2019

The Journal of Emergency Medicine

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Impact of a Multidisciplinary Treatment Pathway for Atrial Fibrillation in the Emergency Department on Hospital Admissions and Length of Stay: Results of a Multi‐Center Study

Ptaszek

Baugh

Lubitz

et al. 2019

JAHA

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BackgroundVariability in the management of atrial fibrillation (AF) in the emergency department (ED) leads to avoidable hospital admissions and prolonged length of stay (LOS). In a retrospective single‐center study, a multidisciplinary AF treatment pathway was associated with a reduced hospital admission rate and reduced LOS. To assess the applicability of the AF pathway across institutions, we conducted a 2‐center study.Methods and ResultsWe performed a prospective, 2‐stage study at 2 tertiary care hospitals. During the first stage, AF patients in the ED received routine care. During the second stage, AF patients received care according to the AF pathway. The primary study outcome was hospital admission rate. Secondary outcomes included ED LOS and inpatient LOS. We enrolled 104 consecutive patients in each stage. Patients treated using the AF pathway were admitted to the hospital less frequently than patients who received routine care (15% versus 55%; P<0.001). For admitted patients, average hospital LOS was shorter in the AF pathway cohort than in the routine care cohort (64 versus 105 hours, respectively; P=0.01). There was no significant difference in the average ED LOS between AF pathway and routine care cohorts (14 versus 12 hours, respectively; P=0.32).ConclusionsIn this prospective 2‐stage, 2‐center study, utilization of a multidisciplinary AF treatment pathway resulted in a 3.7‐fold reduction in admission rate and a 1.6‐fold reduction in average hospital LOS for admitted patients. Utilization of the AF pathway was not associated with a significant change in ED LOS.

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Implementation of a Novel Algorithm to Decrease Unnecessary Hospitalizations in Patients Presenting to a Community Emergency Department With Atrial Fibrillation

Abstract: Implementation of a novel algorithm to identify and treat low-risk patients with AFib can significantly decrease the rate of hospital admissions without increased ED returns. This simple algorithm could be adopted by other community hospitals and help lower costs.

Cited by 6 publications

References 18 publications

Improving care for patients with atrial fibrillation through the use of a personal electrocardiogram

Improving care for patients with atrial fibrillation through the use of a personal electrocardiogram

Interventions to Improve Emergency Department–Related Transitions in Care for Adult Patients With Atrial Fibrillation and Flutter

Impact of a Multidisciplinary Treatment Pathway for Atrial Fibrillation in the Emergency Department on Hospital Admissions and Length of Stay: Results of a Multi‐Center Study

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