Physician research at Massachusetts General Hospital (MGH) identified quality issues with anticoagulation management of new anticoagulation patients and an inconsistent approach to discharge planning and transition.  The research raised particular concerns about how to best “bridge the gap” between inpatient and outpatient anticoagulation management.

Specific goals of the program include:

• Dispatch goal is to facilitate the expanded and efficient use of low molecular weight heparin/warfarin overlap therapy to facilitate hospital discharge prior to achieving therapeutic level of warfarin.
• Provide personalized anticoagulation therapy.  RNs make dosing decisions based on computerized algorithms and hospital guidelines.

In 2001, MGH formed an interdisciplinary anticoagulation team to look for opportunities to improve the quality and efficiency of anticoagulation management.  The team began a pilot project in the neurology department to study effects of comprehensive anticoagulation management.  Positive pilot results lead to the creation of a focused committee and a pathway for high-risk patients starting warfarin therapy.

MGH’s efforts to improve anticoagulation therapy evolved to include other departments and cross-continuum concerns.  Eventually, the Nursing Model for Anticoagulation Management is created, and full rollout of the model occurs in 2004. 

MGH invested $800,000 and two FTEs to redesign the outpatient software system and integrate computer decision support for induction.