Interventions designed to improve the safety and quality of therapeutic anticoagulation in an inpatient electronic medical record

Austin, Jodie A; Barras, Michael; Sullivan, Clair

doi:10.1016/j.ijmedinf.2019.104066

Cited by 16 publications

(41 citation statements)

References 37 publications

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“…Of 4432 potentially relevant studies, we included 19 systematic reviews in 20 publications, 1 of which was identified in our gray literature search. 20 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 The most common reason for exclusion was that the systematic review did not describe a hospital-led intervention. Study selection is shown in the Figure .…”

Section: Resultsmentioning

confidence: 99%

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Interventions to Reduce Hospital Length of Stay in High-risk Populations

et al. 2021

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Key Points Question Which hospital-led interventions are associated with reducing length of stay (LOS) for high-risk populations? Findings In this systematic review including 19 systematic reviews, 8 strategies for reducing LOS in high-risk populations were identified: discharge planning, geriatric assessment, medication management, clinical pathways, interdisciplinary or multidisciplinary care, case management, hospitalist services, and telehealth. Interventions were most frequently designed for older patients or patients with heart failure and were often associated with inconsistent outcomes in LOS, readmissions, and mortality across populations. Meaning This systematic review found that across all high-risk populations, there are inconsistent results on the effectiveness associated with interventions to reduce LOS, such as discharge planning, which are often widely used by health systems.

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Section: Resultsmentioning

confidence: 99%

“…Of 19 systematic reviews analyzed, 10 included a mix of study designs (eg, randomized clinical trials [RCTs], observational cohort studies), 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 8 included only RCTs, 20 , 42 , 43 , 44 , 45 , 46 , 47 , 48 and 1 included only retrospective cohort studies. 49 …”

Section: Resultsmentioning

confidence: 99%

Interventions to Reduce Hospital Length of Stay in High-risk Populations

et al. 2021

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“…Only 5 of 27 studies evaluated the CDS tool impact in terms of morbidity, mortality, and hospital readmissions. 25 Our study provides further evidence on the value of integrating the MAPPP app into additional hospital EHRs and measuring outcomes as part of patient safety goals. The perioperative management of anticoagulation is included as a new Improvement Activity in the Medicare Quality Payment program and additionally is a new requirement for Joint Commission National Patient Safety Goals (NPSG.03.05.01) for the Hospital Accreditation Program.…”

Section: Discussionmentioning

confidence: 66%

“…Only 5 of 27 studies evaluated the CDS tool impact in terms of morbidity, mortality, and hospital readmissions. 25 …”

Section: Discussionmentioning

confidence: 99%

Implementation of the Management of Anticoagulation in the Periprocedural Period App Into an Electronic Health Record: A Prospective Cohort Study

Spyropoulos

Giannis

Cohen

et al. 2020

Clin Appl Thromb Hemost

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Appropriate perioperative management of patients on chronic oral anticoagulation (OAC)—including warfarin and the direct oral anticoagulants—is a poorly defined yet important clinical issue with potentially severe consequences in the postoperative period. We sought to prospectively evaluate the effect of the Management of Anticoagulation in the Periprocedural Period (MAPPP) mobile app as a clinical decision tool in the management of patients on chronic OAC undergoing elective procedures or surgeries. Between January 1, 2018, and January 31, 2019, 642 patients treated in our health system were included. Eligible patients met the following criteria: age >18 years old, creatinine clearance ≥15 mL/min, and on chronic OAC with adequate information regarding baseline characteristics. Our study outcome was patient’s emergency department (ED) visits within 30 days postprocedure. The MAPPP app was integrated into the electronic health record (EHR), and the end user was free to accept or decline recommended evidence-based perioperative anticoagulation management guidance. Analysis revealed that acceptance was more common in younger patients ( P = .0137), patients on oral anticoagulants other than warfarin ( P < .0001), and patients undergoing increased bleeding risk procedures ( P = .0068). Acceptance of the MAPPP app recommendation was significantly associated with fewer ED visits (acceptance group: 4.0% vs rejection group: 8.3%, P = .0205). Logistic regression showed that intervention acceptance and female gender were significantly associated with fewer—while age ≥80 with more—30-day ED visits. Our findings indicate that newer technologies, such as the MAPPP app, integrated into clinical EHR workflow, can significantly augment evidence-based perioperative anticoagulation management and potentially result in a reduction of adverse outcomes.

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“…Следует отметить, что на частоту назначения антикоагулянтов могут влиять не только внешние факторы для медицинской организации (появление новых результатов исследований, клинических рекомендаций), но и внутренние изменения -разработка и внедрение ЭСППР, информирующих врача об актуальных клинических рекомендациях, применимых в конкретном клиническом случае. По данным обзора J. Austin и соавт., наибольшее влияние на безопасность и качество антикоагулянтной терапии в стационаре оказывают ЭСППР, внедренные в медицинские информационные системы и системы электронных врачебных назначений [10].…”

Section: материал и методыunclassified

Changes in anticoagulant prescription in a general hospital in 2008-2018

Kleymenova

Отделенов

Nigmatkulova

et al. 2021

Racionalʹnaâ farmakoterapiâ v kardiologii

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Aim. To study the structure of anticoagulant prescription in a general hospital to identify trends and contributing factors.Materials and methods. The study was conducted in an urban general hospital. According to retrospective retrieval from electronic health records, total 17,129 patients received anticoagulants from 2008 to 2018. Formal appropriateness of oral anticoagulants (OАС) prescriptions for 6,638 patients with atrial fibrillation (AF) was analyzed with CHA2-DS2-VASc score.Results. Appearance of recommendations for the direct oral anticoagulants (DOAC) prescription in clinical guidelines for venous thromboembolism (VTE) and AF management contributed to steady increase in the DOAC taking and decrease in the proportion of warfarin prescription. From 2011 to 2018, the proportion of patients with DOACs prescription increased from 1.7% to 81.5%. The most common indications for anticoagulant were ischemic stroke prevention in AF and VTE with mean rate 75.3% and 23.2%, respectively for the 2011-2018 period. Steady increase in low-molecular-weight heparin (LMWH) prophylactic prescriptions was also shown (Chi-square for linear trend=1340, df=1, p<0.0001). Since 2014, the prescription of LMWH in prophylactic doses increased dramatically, probably related to implementation of computerized decision support system (CDSS) for VTE prevention in the hospital.Conclusion. The study showed that in a general hospital anticoagulants were prescribed in 19% of hospitalized patient. Not only the new clinical recommendations based on the results of the recent studies on anticoagulants efficacy and safety (external factors), but also implementation standard operating protocols and CDSS, providing physicians current information about the relevant clinical recommendations (internal changes), could influence the appropriateness of anticoagulants prescription.

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Interventions designed to improve the safety and quality of therapeutic anticoagulation in an inpatient electronic medical record

Cited by 16 publications

References 37 publications

Interventions to Reduce Hospital Length of Stay in High-risk Populations

Interventions to Reduce Hospital Length of Stay in High-risk Populations

Implementation of the Management of Anticoagulation in the Periprocedural Period App Into an Electronic Health Record: A Prospective Cohort Study

Changes in anticoagulant prescription in a general hospital in 2008-2018

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