For the sixth year in a row, a multidisciplinary team at UNC Hospitals that includes UNC Eshelman School of Pharmacy faculty has been recognized by the American Society of Health-System Pharmacists with a National Best Practices Award for reducing hospital admissions for atrial fibrillation patients by nearly 30 percent.
The UNC team was selected as one of six recipients in the country. The award-winning project is titled, “Optimizing the Management of Patients Presenting to the Emergency Department with Atrial Fibrillation: Pharmacists at the Center of a New Treatment Paradigm.”
Atrial fibrillation, the most common form of abnormal heartbeat in adults, occurs when the upper chambers of the heart (the atria) beat irregularly. The estimated annual cost of AF is $6.65 billion, two-thirds of which is due to the cost of hospitalization as 70 percent of atrial-fibrillation admissions are through the emergency department.
Best practices and quality data to guide the management of atrial fibrillation patients in the emergency department are limited. The UNC team, led by Primary Investigator Anil Gehi, M.D., worked with the Departments of Cardiology and Kevin Biese, M.D., in the Department of Emergency Medicine to develop a triage protocol to categorize AF patients entering the emergency department according to risk level based on hemodynamic stability and symptom severity into low, moderate or high risk categories. At the same time, the team created clinic note templates to assess stroke risk, symptoms and control of key risk factors.
The team reduced the rate of AF patients admitted to the hospital from 81.7 percent to 51.7 percent by preventing unnecessary admissions.
“The most significant reward of this project by far has been helping our patients avoid unnecessary admission to the hospital and become more educated about their disease state so that they are empowered to better manage their own health in the long term,” said Leah Hatfield, Pharm.D., assistant professor of clinical education at the School and a member of the winning team. “My hope for our next step would be to help employ this model at other facilities, and ultimately change the course of standard patient care for atrial fibrillation.”
Patient education materials focused on risk reduction and self-care during AF episodes for both the emergency department and clinic, and an operational workflow delineated roles and provided a clear plan for after-hours consultation and scheduling. By successfully implementing a novel care pathway to triage and discharge AF patients form the emergency department, the team hopes to reduce unnecessary hospital admission and improve quality of atrial fibrillation care.
The award-winning team consisted of
- Zack Deyo, Pharm.D., clinical pharmacist practitioner at the UNC Heart and Vascular Center and adjunct assistant professor at the School;
- Leah Hatfield, Pharm.D., clinical pharmacist specialist at UNC Hospitals and assistant professor of clinical education at the School;
- Philip Mendys, Pharm.D., senior director at Pfizer and adjunct assistant professor of medicine and pharmacy at UNC Chapel Hill;
- Heather Tuttle, trauma outreach coordinator and mid-Carolina RAC coordinator at UNC Health Care;
- Jennifer Walker, M.S., nurse practitioner at UNC Health Care and adjunct faculty member at UNC School of Nursing
- Kevin Biese, M.D, associate professor of emergency medicine and internal medicine and vice-chair of academic affairs
- Anil Gehi, M.D., associate professor of medicine and program director of Clinical Cardiac Electrophysiology Fellowship.
Between January and June 2015, 100 patients coming into the UNC Hospitals Emergency Department received a primary diagnosis of atrial fibrillation. Eighty-one were admitted to the hospital for an average of three days per patient. The team then implemented their new care pathway. Between July 2015 and March 2016, 98 patients came to the emergency department and were diagnosed with AF. Of these patients, 56 were admitted to the hospital for an average of 2.5 days per patient, and 42 patients were discharged from the ED.
“This is one example of a way to repurpose traditional warfarin-focused anticoagulation clinics where, with the advent of direct oral anticoagulants, management has arguably become more complex,” Deyo said. “We hope to assess scalability to other areas in our institution, such as accepting referrals from urgent care and primary care.”