Electronic alerts to initiate anticoagulation dialogue in patients with atrial fibrillation

Gutiérrez, Jorge; Ruff, Christian T.; Aday, Aaron W.; Gu, Liqun; Schulteis, Ryan D.; Shihai, L; Petrini, Michaela; Sun, Albert Y.; Swaminathan, Rajesh V.; Katzenberger, D R; Banerjee, Sourish; Rao, Saahithi

doi:10.1016/j.ahj.2021.11.008

Cited by 4 publications

(1 citation statement)

References 9 publications

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“…9 Triggers utilized to notify a provider when a patient with atrial fibrillation is not anticoagulated in an effort to stimulate more conversations about starting anticoagulation have proven to be beneficial. 10 The trigger tools for identifying need for PC in other diseases have shown to increase access. 11 However, EMR use to standardize PC delivery for a stroke patient is not a well-studied area.…”

Section: Introductionmentioning

confidence: 99%

Improving Access to Specialist Palliative Care for Patients With Catastrophic Strokes Using Best Practice Advisory- a Feasibility Study

Nagpal

Osgood

Reidy

et al. 2023

The Neurohospitalist

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Background and Purpose The American Heart Association and American Stroke Association (AHA/ASA) strongly recommend specialty palliative care (PC) for all patients hospitalized with life-threatening or life-altering strokes to provide expert symptom management, improve communication, promote shared decision-making and relieve suffering. We piloted an intervention to remind physicians about high PC needs of their patients admitted with catastrophic stroke. Methods We worked with colleagues from medical informatics to create a “Best Practice Advisory” (BPA) to recommend a goals-of-care conversation and PC consultation for patients with a National Institutes of Health Stroke Scale (NIHSS) score of 20 or more in our electronic medical record (Epic). We evaluated the impact of this BPA, after implementation, on the number and timing of PC consults and reviewed barriers to this system change. Results The BPA was operational in Jan 2019. Data analysis showed that it fired for all patients with an entered NIHSS score of ≥20. Though a large portion of the BPAs (more than 90%) were acknowledged without documented reason (after selecting “do not order”), PC consultations per 100 patients with triggered BPA increased from the first year of implementation (11.7 in 2019) to the next 2 years (20.7 in 2020, 15.6 in 2021). Also, the providers learned to manage BPA alerts better resulting in more than 30% reduction in the number of BPA alerts fired for each patient encounter in 2020-2021 compared to 2019.

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Section: Introductionmentioning

confidence: 99%