Abstract 137: Using an Electronic Clinical Support Tool to Improve Anticoagulation in Patients with Atrial Fibrillation/Flutter

Abstract

Background: It is estimated that atrial fibrillation (AF) impacts between 2.7 to 6.1 million American adults, and this is expected to double by 2050. The outpatient performance measures of the 2016 AHA/ACC Clinical Performance and Quality Measures include: Documentation of CHA2DS2-VASc Risk Score and anticoagulation (AC) prescription, when indicated. To address these outpatient measures, our team integrated a clinical support tool into our electronic medical record (EMR). Objectives: Our quality improvement project aimed to increase the percentage (or proportion) of patients with atrial fibrillation/flutter (AF) who were appropriately prescribed AC in an academic cardiology clinic. Our outcome measure was the frequency our tool was either: acknowledged, cancelled, or completed. Methods: Baseline data was collected via retrospective chart review for patients with documented AF. With the assistance of information technology, we created a pop-up clinical tool in the EMR that recognized if the patient is prescribed AC and provided a semi-automated calculation of the CHA2DS2-VASc score. If the patient had CHA2DS2-VASc ≥ 2 and was not on AC, the tool prompted the physician to select either: a contraindication, refusal or prescribe AC. Before implementing the electronic tool, the cardiologists were educated on the new tool and made aware of future data collection. Results: Baseline data from April 2018 included 104 patients with AF, of which 57.7% were prescribed AC. The frequency of AC prescription for all AF over the next 3 months increased: 76% in May, 69% in June, 86% in July. For these 3 months, when the clinical decision tool was encountered: 69 - 72% of cardiologists cancelled, 11 - 22% acknowledged, and 9-17% used the tool. Conclusion: Our outcome measure to increase AC prescription was achieved following implementation of an electronic clinical tool even though the cardiologists often did not interact with the tool. Similar to prior literature on clinical support tools, the provider’s clinical proficiency plays a large role in use. The tool may have been successful by providing a clinical reminder about AC in these patients . Early results show sustainability in AC prescription. Our clinical tool is now being implemented into a primary care clinic and may have increased use in that setting.