Anticoagulation report has little impact in discharge summary

(HealthDay)—For patients on warfarin, an anticoagulation report that is embedded in the discharge summary has no impact on clinical outcomes, although it is perceived to improve patient safety, according to a study published in the September issue of the Journal of Hospital Medicine.

Andrew S. Dunn, M.D., M.P.H., from the Mount Sinai Health System in New York City, and colleagues aimed to develop a concise report to improve the timeliness of international normalized ratio (INR) testing and quality of warfarin management after hospitalization. The authors developed the Safe Transitions Anticoagulation Report (STAR), which included essential information on anticoagulation and was inserted into the discharge summary. Following implementation of the report and associated workflow, a retrospective administrative database review was performed involving 505 patients in the preintervention period and 292 in the intervention period.

The researchers found that the frequency of obtaining an INR value within 10 days of discharge did not vary for the preintervention and intervention periods (41.4 and 47.6 percent, respectively; P = 0.09). Furthermore, there was no increase in attaining a therapeutic INR level within 10 days of discharge (17.0 and 21.2 percent, respectively; P = 0.14). STAR was reported to improve "workflow and efficiency" and "patient safety" (by 77 and 58 percent of respondents, respectively), while 34 percent of survey respondents reported that it affected their choice of warfarin dose.

"This electronic medical record tool would need to be a component of a broader multifaceted intervention to be effective," the authors write.

The study was funded by a grant from the Cardinal Health E3 Foundation.

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