title: A Clinical Network Project Improves Care of Patients with Atrial Fibrillation with Rapid Ventricular Response in Victorian Emergency Departments.
abstract: OBJECTIVE
  Atrial fibrillation with rapid ventricular response is a common condition in emergency departments (ED) and despite published guidelines, variation in practice is common. The aim of this nine-month evidence-based care improvement project was improving the management of atrial fibrillation with rapid ventricular response (AFRVR).
  
  
  METHODS
  This was a quality improvement project, evaluated using before and after chart review methodology. The outcomes of interest were the proportion of patients managed according to a local treatment pathway, the proportion with duration of symptoms documented, the proportion with rate control versus rhythm control strategy documented and the proportion with a CHADS2 score (or equivalent) documented.
  
  
  RESULTS
  Ten ED participated. Management according to a local treatment pathway increased from 8% (27/326) of patients to 68% (191/281); p<0.0001. The proportion of patients with symptom duration documented increased from 62% (201/326) to 81% (227/281); p<0.0001. The proportion of patients with CHADS2 score (similar) documented increased from 16% (49/310) to 47% (126/268); p<0.0001.
  
  
  CONCLUSIONS
  This project has led to clinically and statistically significant improvements in management of AFRVR across a health system, although there is still room for improvement. Work continues to embed these gains and make further improvements.
authors.affiliation: Department of Health and Human Services, Melbourne, Vic, Australia. Electronic address: anne-maree.kelly@wh.org.au.
authors.forename: Anne-Maree
authors.initials: AM
authors.lastname: Kelly
authors.affiliation: Department of Health and Human Services, Melbourne, Vic, Australia.
authors.forename: Jan
authors.initials: J
authors.lastname: Pannifex
mesh_terms: D001281:Atrial Fibrillation / Q000503:physiopathology / Q000628:therapy*; D019058:Community Networks; D003695:Delivery of Health Care; D005260:Female; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D011785:Quality Assurance, Health Care; D014739:Victoria
keywords: Atrial fibrillation; Change; Emergency department; Quality improvement