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Abstract

Introduction: The Joint Commission National Patient Safety Goals outlines standards for maintaining safety during anticoagulation. As part of Rush University Medical Center’s effort to improve quality and patient safety, we implemented a pharmacy-directed anticoagulation service. The purpose of this study was to evaluate the impact of this pharmacy-directed anticoagulation service on transition of care and clinical outcomes associated with anticoagulation therapy. Hypothesis: Implementation of a pharmacy-directed anticoagulation service will provide improvement in transition of care and clinical outcomes associated with warfarin therapy. Methods: This was a single-center, prospective cohort study with retrospective historical control patients. Inclusion criteria were patients 18 years or older, admitted to general medicine floor who received at least one dose of warfarin during admission and were discharged to follow-up with a Rush physician at a clinic. The primary endpoint of this study was the successful transition of care to the next provider of care at discharge. The secondary endpoints were clinical outcomes associated with warfarin therapy measured by International Normalized Ratio (INR) greater than 5, thrombosis, minor bleeding, major bleeding, anticoagulation-related emergency department (ED) visit, or anticoagulation-related readmission within 30 days of discharge. Results: The study included 88 patients with 44 patients in each group. The primary endpoint, successful transition of care occurred in 31 patients (70.5%) in the intervention group compared to 19 patients (43.2%) in the control group (p=0.01). There was no statistically significant difference in the secondary endpoints of INR greater than 5, thrombosis, minor bleeding, major bleeding, anticoagulation-related ED visit, or anticoagulation-related readmission within 30 days of discharge between the two groups. A composite of the secondary endpoints also showed no statistically significant difference between the two groups (p=0.06). Conclusions: Implementation of a pharmacy-directed anticoagulation service improved anticoagulation transition of care after discharge and showed trends towards improved clinical outcomes with warfarin.