An anticoagulation pathway for quality management

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p ERIOPERATIVE ANTICOAGULATION REQUIREMENTS increase the complexity of managing surgical patients. Postponement of surgery, a preoperative admission, increase in postoperative length of stay (LOS) for dosage titration, or development of postoperative complications can occur in the surgical patient requiring anticoagulation. Significant increases in cost, patient safety, and delays in patients returning to their prior preoperative functional baseline can result. Although outpatient warfarin (Coumadin) management and algorithms have been available for a long time (Vadher, Patterson, & Leaning, 1995; Wenger, 1996; Wilt, Gums, Osman, & Moore, 1995), they do not easily translate to the inpatient setting where hospitalization and invasive interventions create dosing interruptions. An ultimate solution to this problem, after two studies, was the creation of an pathway. This pathway addresses the anticoagulation process for both hepafin and Coumadin guiding practice from preintervention through discharge. The studies described in this article were conducted as part of the medical center's clinical process improvement program for quality improvement purposes and were deemed exempt from informed consent by the medical center's Institutional Board of Research Associates (IRBA). The information was recorded in a manner such that subjects could not be identified and was used solely to create a clinical pathway to improve the quality of patient care. BACKGROUND