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Improvement in documentation rates for resumption of antithrombotic agents after elective endoscopy using an
Jeffrey Than1, Terrance Rodrigues1, Mary Kwasny2
1Division of Gastroenterology and Hepatology, Department of Medicine (1)Northwestern University, Chicago, Illinois, USA.
Background And Aims:
Resumption recommendations for anticoagulants (ACs) and antiplatelet agents (APAs) after endoscopy are inconsistently documented, which has been associated with a small but clinically significant number of adverse events (AEs). Clinical decision support systems must be implemented properly to ensure high adoption and clinically appropriate use. This study aimed to improve the rate of documentation of resumption recommendations for ACs and APAs using an electronic health record-based intervention integrated into the existing clinical workflow.
Methods:
We implemented a soft-stop endoscopy software alert to trigger if resumption recommendations were not initially documented in patients on ACs and APAs. The rates of documentation of resumption recommendations were compared between pre- and postintervention periods.
Results:
Across 1238 encounters for elective outpatient endoscopy, there was no difference in AC and APA use between pre- and postintervention periods. More endoscopies were performed in patients taking ACs (77.9%) compared with those taking APAs (25.3%). The intervention led to a significant increase in documentation of resumption recommendations postintervention from 47.1% (95% confidence interval [CI], 42.6-51.6) and 41.6% (95% CI, 34.1-49.6) to 70.5% (95% CI, 66.3-74.4; P < .001) and 73.1% (95% CI, 65.6-79.4; P < .001) in patients on ACs and APAs, respectively. Patients who were older, undergoing colonoscopy, or female were more likely to have documentation of recommendations, whereas those undergoing endoscopic ultrasound (EUS) or endoscopic retrograde cholangiopancreatography (ERCP) on ACs were less likely to have recommendations documented. Sedation type and the presence of a fellow did not impact documentation rates.
Conclusions:
Implementing an electronic health record-based intervention into the existing endoscopy workflow improved the documentation of resumption recommendations for antithrombotic medications after elective outpatient endoscopy.
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