Transition of care for patients with venous thromboembolism: Rationale, design and implementation of a quality intervention project conducted at American Thrombosis and Hemostasis Network (ATHN) affiliated sites

Abstract

IntroductionMedication errors frequently occur during transition from the inpatient to outpatient setting. Anticoagulants are associated with serious medical errors, including major bleeding. Standardized transition of care (TOC) techniques in patients with venous thromboembolism (VTE) have not been developed. MethodsThis ongoing project conducted by the American Thrombosis and Hemostasis Network (ATHN) aims to improve TOC for newly diagnosed VTE patients on anticoagulation from the inpatient to outpatient setting, and identify characteristics of patients on direct oral anticoagulants (DOACs) and their TOC. There are two main phases, a Pre-Intervention and a Quality Intervention Phase. For both phases data are collected regarding patient demographics, VTE characteristics, and patients' knowledge and feedback regarding their VTE and anticoagulant discharge instructions. In addition, for the Quality Intervention Phase, a standardized comprehensive discharge instruction module specific for each anticoagulant is administered followed by a one-week phone call. ResultsSixteen ATHN-affiliated sites are participating. There are 218 patients enrolled in the Pre-Intervention Phase. The majority are adults (58.5%), women (52.4%) and non-Hispanic ethnicity (82.2%). The main risk factors for VTE were length of hospital stay of more than seven days and obesity in the pediatric and adult population respectively. Enoxaparin and DOACs were predominantly prescribed for the pediatric and adult population respectively. ConclusionThis TOC quality intervention initiative for newly diagnosed patients with VTE aims to demonstrate that implementation of a standardized TOC model is feasible and can improve patient knowledge, satisfaction, compliance, reduce anticoagulant complications and hospital readmissions in both the pediatric and adult populations.