A Novel Orderset Driven Emergency Department Atrial Fibrillation Algorithm to Increase Discharge and Risk-appropriate...

Area of Science:

• Cardiology
• Emergency Medicine
• Health Informatics

Background:

• Patients with atrial fibrillation (AF) admitted to the emergency department (ED) often do not receive recommended anticoagulation upon discharge.
• This gap in care increases the risk of thrombotic complications for AF patients.

Purpose of the Study:

• To evaluate the impact of a novel computerized ED AF pathway orderset on anticoagulation rates and ED discharge rates for patients with primary AF.
• To assess the effectiveness of a structured approach to managing AF in the ED setting.

Main Methods:

• A prospective study was conducted over 18 months, implementing a computerized orderset for AF management in the ED.
• The orderset included tools for rate/rhythm control, risk assessment (CHADS-VASC, HAS-BLED), anticoagulation recommendations, and specialist follow-up.
• Discharge rates and the rate of guideline-concordant anticoagulation were compared before and after orderset implementation.

Main Results:

• All 56 patients analyzed received guideline-concordant anticoagulation (100%).
• The proportion of AF patients discharged directly from the ED increased significantly, from 29% in the pre-implementation period to 41% in the post-implementation period.
• The increase in discharge rate represented a 12% difference (95% CI, 5-18%).

Conclusions:

• The novel ED AF pathway orderset achieved 100% guideline-concordant anticoagulation for discharged patients.
• Implementation of the AF pathway orderset led to a significant increase in the rate of ED discharges for AF patients.
• This pathway represents an effective strategy to improve anticoagulation management and patient disposition in the ED.