title: Direct admission to cardiology for patients hospitalized for atrial fibrillation reduces length of stay and increases guideline adherence.
abstract: OBJECTIVE
  We hypothesized that a clinical pathway for inpatient management of atrial fibrillation on a cardiology service would result in improved resource utilization.
  
  
  METHODS
  In July 2002, an evidence-based pathway was developed for treatment of patients hospitalized for atrial fibrillation. Guidelines directed patient care from admission from the emergency department to inpatient management on a cardiology service. Ancillary testing, anticoagulation, and inpatient length of stay were then compared before and after institution of the pathway.
  
  
  RESULTS
  The overall length of stay was significantly shorter for patients admitted through the pathway (43.0 hours vs. 82.0 hours, p < 0.01). After the pathway, there was increased use of transesophageal echocardiography and a trend toward increased use of warfarin.
  
  
  CONCLUSIONS
  Patients requiring hospitalization for symptomatic atrial fibrillation had a nearly 50% reduction in length of stay, with a trend toward increased utilization of risk-appropriate antithrombotic therapy, if they were directly admitted through cardiology via a clinical pathway.
authors.affiliation: Wilford Hall Medical Center, Lackland Air Force Base, TX 78236, USA.
authors.forename: Samuel O
authors.initials: SO
authors.lastname: Jones
authors.forename: Micheal
authors.initials: M
authors.lastname: Odle
authors.forename: Karl
authors.initials: K
authors.lastname: Stajduhar
authors.forename: Kenneth
authors.initials: K
authors.lastname: Leclerc
authors.forename: Robert E
authors.initials: RE
authors.lastname: Eckart
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000628:therapy*; D016507:Cardiology Service, Hospital / Q000706:statistics & numerical data*; D019091:Critical Pathways; D003954:Diagnostic Services / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000592:standards*; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006772:Hospitals, Military; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission / Q000592:standards*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants