Anticoagulation service: improving the referral process.

Area of Science:

• Pharmacology
• Health Informatics
• Patient Safety

Background:

• Oral anticoagulants like warfarin are widely prescribed but carry risks of fatal errors due to under- or over-anticoagulation.
• Effective management requires regular International Normalised Ratio (INR) monitoring and dosage adjustments.
• A paper-based referral system at St. Peter's hospital resulted in only 66% of warfarin patients being referred to the anticoagulation service upon discharge.

Purpose of the Study:

• To improve the referral rate of patients on warfarin to the hospital's anticoagulation service.
• To address a significant patient safety issue stemming from inadequate referrals.
• To reduce the risk of life-threatening consequences associated with suboptimal anticoagulation management.

Main Methods:

• Development and implementation of an electronic referral form within an existing computer-based ordering system.
• Streamlining the referral process by making the electronic form quicker, easier to complete, and eliminating faxing.
• Mandating key information on the electronic referral form.

Main Results:

• A post-intervention audit showed an 18% increase in referral rates, with 84% of discharged warfarin patients successfully referred.
• The electronic tool simplified the referral process, improving efficiency and data accuracy.
• The enhanced referral rate is expected to improve patient safety and decrease hospital admissions.

Conclusions:

• Electronic referral systems are effective in improving patient management for anticoagulation therapy.
• Streamlining the referral process enhances patient safety and clinical outcomes.
• Continued education and re-audits are recommended, with future goals including automated referral systems.