title: Quality improvement in an anticoagulation clinic: development of a new treatment protocol.
abstract: We sought to improve patient outcomes and efficiency in our anticoagulation clinic through development of a new protocol for managing heart valve patients with subtherapeutic international normalized ratio (INR) tests. The new protocol standardized use of 1 anticoagulation agent while warfarin was retitrated, timelines for INR retesting, and target INR levels depending on the type of valve implanted. The new protocol provided significant improvements in patient care; however, outcomes for clinic operating efficiency were mixed.
authors.affiliation: Cardiovascular Services and Department of Internal Medicine, Marshall University, Huntington, West Virginia, USA.
authors.forename: Heather R
authors.initials: HR
authors.lastname: Carver
authors.forename: Mark
authors.initials: M
authors.lastname: Studeny
authors.forename: Todd W
authors.initials: TW
authors.lastname: Gress
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Wood
mesh_terms: D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities / Q000458:organization & administration / Q000592:standards*; D000925:Anticoagulants / Q000627:therapeutic use*; D002985:Clinical Protocols / Q000592:standards*; D017598:Efficiency, Organizational; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000451:nursing*; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D015401:Nursing Administration Research; D015403:Nursing Evaluation Research; D010865:Pilot Projects; D057184:Practice Patterns, Nurses' / Q000458:organization & administration*; D058996:Quality Improvement / Q000458:organization & administration*; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin