title: Optimizing Anticoagulation Management Through the Use of a Hospital Engagement Network Metric for Inpatient Anticoagulant-Associated Hemorrhage.
abstract: 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.
authors.affiliation: Beaumont Hospital, Royal Oak, MI, USA Wayne State University, Detroit, MI, USA.
authors.forename: Janet L
authors.initials: JL
authors.lastname: Hoffman
authors.affiliation: Beaumont Hospital, Royal Oak, MI, USA.
authors.forename: Nadia J
authors.initials: NJ
authors.lastname: Aneese
authors.affiliation: Beaumont Hospital, Royal Oak, MI, USA.
authors.forename: Kyle J
authors.initials: KJ
authors.lastname: Schmidt
authors.affiliation: Wayne State University, Detroit, MI, USA.
authors.forename: Alex C
authors.initials: AC
authors.lastname: Chaben
authors.affiliation: Beaumont Hospital, Royal Oak, MI, USA Wayne State University, Detroit, MI, USA maureen.smythe@beaumont.org.
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Smythe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000925:Anticoagulants / Q000009:adverse effects*; D019468:Disease Management; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000188:drug therapy*; D006493:Heparin / Q000009:adverse effects*; D006761:Hospitals; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000925:Anticoagulants; D006493:Heparin
keywords: adverse drug reactions; anticoagulants; anticoagulation; medication safety; quality assurance