Effectiveness of an algorithm‐based care pathway for patients with non‐valvular atrial fibrillation presenting to the emergency department

Masica, Andrew L.; Brown, Rachel M.; Farzad, Ali; Garrett, John S.; Wheelan, Kevin; Nguyen, Hoa L.; Ogola, Gerald; Kudyakov, Rustam; McDonald, Brandy; Boyd, Bethany; Patel, Ashlesha; Delaughter, Craig

doi:10.1002/emp2.12608

Cited by 4 publications

(2 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Five studies improved guideline adherence through antibiotic prescribing guidelines 46 , 80–82 or medical calculators. 83 Masica et al 84 embedded voluntary medical calculators and showed a decrease in hospital admissions. Ramnarayan et al 49 improve documentation quality through a diagnostic support system.…”

Section: Resultsmentioning

confidence: 99%

The role of information systems in emergency department decision-making—a literature review

Born,

Schwarz,

Böttcher

et al. 2024

Journal of the American Medical Informatics Association

View full text Add to dashboard Cite

Objectives Healthcare providers employ heuristic and analytical decision-making to navigate the high-stakes environment of the emergency department (ED). Despite the increasing integration of information systems (ISs), research on their efficacy is conflicting. Drawing on related fields, we investigate how timing and mode of delivery influence IS effectiveness. Our objective is to reconcile previous contradictory findings, shedding light on optimal IS design in the ED. Materials and methods We conducted a systematic review following PRISMA across PubMed, Scopus, and Web of Science. We coded the ISs’ timing as heuristic or analytical, their mode of delivery as active for automatic alerts and passive when requiring user-initiated information retrieval, and their effect on process, economic, and clinical outcomes. Results Our analysis included 83 studies. During early heuristic decision-making, most active interventions were ineffective, while passive interventions generally improved outcomes. In the analytical phase, the effects were reversed. Passive interventions that facilitate information extraction consistently improved outcomes. Discussion Our findings suggest that the effectiveness of active interventions negatively correlates with the amount of information received during delivery. During early heuristic decision-making, when information overload is high, physicians are unresponsive to alerts and proactively consult passive resources. In the later analytical phases, physicians show increased receptivity to alerts due to decreased diagnostic uncertainty and information quantity. Interventions that limit information lead to positive outcomes, supporting our interpretation. Conclusion We synthesize our findings into an integrated model that reveals the underlying reasons for conflicting findings from previous reviews and can guide practitioners in designing ISs in the ED.

show abstract

Section: Resultsmentioning

confidence: 99%

The role of information systems in emergency department decision-making—a literature review

Born,

Schwarz,

Böttcher

et al. 2024

Journal of the American Medical Informatics Association

View full text Add to dashboard Cite

show abstract

“…7,9 Similar to previous studies evaluating different AF treatment pathways in the ED, the utilisation of the AF pathway described in the present study reduced the rate of hospital admission by 30.1% (a net 13.1%). 6,21 Despite the significant reduction in hospitalisation, AFrelated representation and all-cause mortality rates were similar between the two groups, positioning the AF pathway as a safe alternative to early cardioversion and/or inpatient management of acute uncomplicated symptomatic AF/AFL. Furthermore, implementation of this AF treatment strategy likely leads to significant savings by reducing the costs associated with unnecessary cardioversions, avoidable hospitalisations and their potential complications.…”

Section: Discussionmentioning

confidence: 96%

Implementation of an integrated emergency department acute atrial fibrillation pathway safely reduces cardioversions and hospitalisations: A comparative pre–post study

Addy,

Joyce,

Al‐Busaidi

et al. 2023

Emerg Medicine Australasia

View full text Add to dashboard Cite

ObjectiveAtrial fibrillation/flutter (AF/AFL) accounts for high rates of ED presentations and hospital admissions. There is increasing evidence to suggest that delaying cardioversion for acute uncomplicated AF is safe, and that many patients will spontaneously revert to sinus rhythm (SR). We conducted a before‐and‐after evaluation of AF/AFL management after a change in ED pathway using a conservative ‘rate‐and‐wait’ approach, incorporating next working day outpatient clinic follow‐up and delayed cardioversion if required.MethodsWe performed a before‐and‐after retrospective cohort study examining outcomes for patients who presented to the ED in Christchurch, New Zealand, with acute uncomplicated AF/AFL in the 1‐year period before and after the implementation of a new conservative management pathway.ResultsA total of 360 patients were included in the study (182 ‘Pre‐pathway’ vs 178 ‘Post‐Pathway’). Compared to the pre‐pathway cohort, those managed under the new pathway had an 81.2% reduction in ED cardioversions (n = 32 vs n = 6), and 50.7% reduction in all cardioversions (n = 65 vs n = 32). There was a 31.6% reduction in admissions from ED (n = 54 vs n = 79). ED length of stay (3.9 h vs 3.8 h, net difference −0.1 h, 95% confidence interval [CI] −0.6 to 0.3), 1‐year ED AF representation (32.4% vs 26.4%, net difference −6.0% [95% CI −16.0% to 3.9%]), 1‐year ED ischaemic stroke presentation (2.2% in both groups) and 7‐day all‐cause mortality rates (hazard ratio 1.05 [95% CI 0.6 to 1.9]) were all similar.ConclusionsUsing a conservative ‘rate‐and‐wait’ strategy with early follow‐up for patients presenting to ED with AF/AFL can safely reduce unnecessary cardioversions and avoidable hospitalisations.

show abstract

How well do ED physician practices align with the CAEP acute atrial fibrillation checklist for stroke prevention and disposition?

Adler,

Mattice,

Eagles

et al. 2024

Can J Emerg Med

View full text Add to dashboard Cite

Effectiveness of an algorithm‐based care pathway for patients with non‐valvular atrial fibrillation presenting to the emergency department

Cited by 4 publications

References 36 publications

The role of information systems in emergency department decision-making—a literature review

The role of information systems in emergency department decision-making—a literature review

Implementation of an integrated emergency department acute atrial fibrillation pathway safely reduces cardioversions and hospitalisations: A comparative pre–post study

How well do ED physician practices align with the CAEP acute atrial fibrillation checklist for stroke prevention and disposition?

Contact Info

Product

Resources

About