Standardizing peri-procedural antithrombotic therapy instructions in a community hospital

ObjectiveOur study describes improvement in patient adherence to guidelines for peri-procedural management of antithrombotic therapy following development of protocols and implementation of a standardized process to deliver instructions to patients who are scheduled to undergo procedures in the community hospital setting.MethodsBaseline data revealed suboptimal patient adherence to guidelines for peri-procedural management of aspirin, warfarin, and clopidogrel (Douketis et al., 2012)1. We convened a multidisciplinary stakeholder group to develop standard protocols for patients taking these medications. Following protocol development, we standardized the patient instruction process to enhance its reliability, improve patient satisfaction, and streamline physician office workflow. We compared data on patient adherence to published guidelines for peri-procedural management pre and post development of the protocols and implementation of a standardized instruction process.ResultsOur pilot results demonstrated improvement in adherence to published guidelines for aspirin, warfarin, and clopidogrel patients. Results achieved statistical significance for aspirin patients, but our study was underpowered to detect statistically significant changes for warfarin and clopidogrel. Review of the evidence, data collection focusing on improved adherence to evidence-based guidelines and prevention of adverse events, streamlined workflow, and increased accountability for non-adherence to best practice should all be employed as strategies for successful adoption.ConclusionDevelopment of institutional instruction protocols allowed for delivery of standard preoperative instructions to patients. Standardizing the patient instruction process improved patient adherence to evidence based guidelines for peri-procedural management of aspirin, warfarin, and clopidogrel. Our initiative identifies strategies to overcome barriers to quality improvement efforts that may be more unique to the community hospital setting, where resources are less readily available than in an academic medical center. Improved patient adherence to published guidelines should prompt future work to determine the effects of standardization on outcomes such as mortality and complications (bleeding or thromboembolic), patient, and staff satisfaction.