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

Steven K Roumpf1, Jeffrey A Kline1,2, Gopi Dandamudi3

  • 1Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN.

Critical Pathways in Cardiology
|August 22, 2022
PubMed

Insights

A new computerized pathway for atrial fibrillation (AF) in the emergency department (ED) ensured all patients received appropriate anticoagulation. This pathway also increased the number of AF patients discharged directly from the ED.

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.
Abstract

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