Implementation of a transitions of care and care coordination service for patients with acute venous thromboembolism in the emergency department and observation unit

Service or Program:

The pharmacy team at an urban academic medical center implemented a transitions of care process for patients with  acute venous thromboembolism (VTE) being discharged directly from the emergency department  or observation unit to the outpatient setting on direct oral anticoagulants (DOACs). The pharmacy team established interprofessional workgroups, patient assistance options for DOACs, and electronic health record (EHR) order-sets and alerts to facilitate the process. The pharmacist's role includes ensuring appropriate DOAC prescribing, providing patient education prior to discharge, care coordination during the transition to outpatient, and post-discharge care and follow-up.

Justification/Documentation:

The cost of care and length of stay rendered by hospitalizations for the treatment of VTE continues to contribute to the economic burden on our health care system. The standard of care for acute VTE has historically been an oral vitamin K antagonist with low-molecular weight heparin bridging. However, discharge on DOAC therapy from the site of diagnosis, which is often the emergency department or observation unit, decreases hospital length of stay and reduces health care costs. Pharmacists have the opportunity to provide dosing recommendations, patient education, and care coordination during this process to ensure safe and efficacious therapy.

Transferability:

Prior to implementation of this process, a relationship must be established between the pharmacists, physicians, nursing staff, and management staff to facilitate interprofessional collaboration. Furthermore, access to patient medication assistance is important for the transition of uninsured and underinsured patients to the outpatient setting. Utilization of EHR capabilities can assist in workflow and patient prioritization for prescribers, pharmacists, and nurses.

Impact:

We anticipate that this transitions of care process will reduce hospital length of stay and cost of care, while improving care coordination. Furthermore, this process will improve patient safety, increase pharmacy interventions, and justify further positions for pharmacists to provide care coordination and effective transitions of care in various settings.