Optimizing Anticoagulation Management Through the Use of a Hospital Engagement Network Metric for Inpatient Anticoagulant-Associated Hemorrhage.
BACKGROUND
The University HealthSystem Consortium (UHC), a national hospital engagement network (HEN), establishes health-system metrics to assess and improve quality of care. In 2012, a metric for inpatient anticoagulant hemorrhage was developed. The utility of this metric to improve anticoagulation care has not been assessed.


OBJECTIVE
To identify opportunities to improve anticoagulation safety through the use of a HEN metric for inpatient anticoagulant-associated hemorrhage.


METHODS
This was a single-center, retrospective, observational study of metric identified patients with presumed inpatient anticoagulant hemorrhage. Records were reviewed to confirm anticoagulant hemorrhage and identify bleed site and severity. A structured process was used to assess bleed preventability and subsequently identify opportunities for improving care. Each bleed was reviewed by 2 investigators.


RESULTS
Anticoagulant hemorrhage was confirmed in 85.9% (61/71) with heparin infusion the most common anticoagulant. Patients were primarily medical, with a mean age of 72.7 ± 15 years. The most common bleed sites were gastrointestinal (24.6%) and retroperitoneal (21.3%). Major bleeding occurred in 60.7% (37/61). Anticoagulant hemorrhage was preventable in 18% (11/61) of cases with heparin protocol noncompliance the most common cause of a preventable bleed. Several opportunities for improving heparin infusion therapy were recognized and protocol changes were implemented.


CONCLUSIONS
The UHC metric accurately captures inpatient anticoagulant-associated hemorrhage the majority of time. The UHC metric on anticoagulant-associated hemorrhage can be a useful part of a health system's overall plan for the safe use of anticoagulants in the hospital setting.
['Hoffman|Janet L|JL|', 'Aneese|Nadia J|NJ|', 'Schmidt|Kyle J|KJ|', 'Chaben|Alex C|AC|', 'Smythe|Maureen A|MA|']
D000368:Aged D000369:Aged, 80 and over D000818:Animals D000925:Anticoagulants D019468:Disease Management D005260:Female D006470:Hemorrhage D006493:Heparin D006761:Hospitals D006801:Humans D007297:Inpatients D008297:Male D008875:Middle Aged D011787:Quality of Health Care D012189:Retrospective Studies D012307:Risk Factors
anticoagulants anticoagulants adverse drug reactions anticoagulation medication safety quality assurance