Hospital-to-facility transitions for antithrombosis patients: Perilous junctures requiring focused stewardship

Abstract

Background

To assess the impact of receipt of a comprehensive anticoagulation communication note on need for Antithrombosis Stewardship care transition interventions from the hospital to post-acute care facilities.

Methods

This was a retrospective, single-center observational analysis of care transitions interventions among patients discharged on therapeutic-intensity anticoagulants from an academic medical center to post-acute care facilities (PACFs). The pre-intervention group followed standard institutional antithrombosis stewardship practices to transmit an ‘Anticoagulation Communication at Discharge’ (ACDC) note plus follow-up call. The post-intervention cohort added a preparatory call to obtain the best contact information for direct transmission of anticoagulation information to the clinical team.

Results

The final analysis included 712 patients (605 patients in pre-intervention group and 107 patients in post-intervention group). Receipt of the ACDC note was confirmed in 45% (272/605) patients in the pre-intervention cohort compared to 58% (62/107) in the post-intervention cohort (p = 0.013). Of the patients who did not have confirmed receipt in the pre-intervention period, 12% (41/333) required intervention to optimize therapy compared to 5% (14/272) who had confirmed receipt (RR 2.2, p = 0.002). Similarly, in the post-intervention cohort, patients who did not have confirmed receipt required intervention (5/45) more frequently than patients with confirmed receipt (4/62) (11% vs. 6%; p=0.391).

Conclusion

Focused antithrombosis stewardship efforts to support improved communication of key patient information between facilities may be associated with a reduced need for clinical intervention during care transitions.