Study Suggests Warfarin Management Program Reduces Hospitalizations


A simple electronic prompt that appears in patients’ charts if they are prescribed a popular blood thinner is associated with reduced hospitalizations, according to a new study from the University of Missouri School of Medicine.

Patients are prescribed anticoagulation drugs for blood clots, heart arrhythmias and as a preventative measure after some surgeries or injuries. A commonly used blood thinner, warfarin, carries significant risks of bleeding or clotting complications. That’s why doctors closely manage its use.

A team from MU Health Care led by Margaret Day, MD, MSPH, FAAFP, associate professor of family and community medicine, examined how using an electronic health record (EHR) order for warfarin management impacted patients of all ages taking warfarin for any reason between September 2013 and September 2017. After implementing the warfarin EHR intervention, hospitalizations decreased by nearly 20%.

Dr. Margaret Day
Dr. Margaret Day

“Using EHR tools to improve patient safety is a strength of MU Health Care,” Day said. “Balancing the treatment needs of our patients’ conditions with the overall comprehensive care of them as a person is done more effectively with the tools our robust information technologies can provide.”

Day worked with the Tiger Institute for Health Innovation to implement the order into the EHR. If a patient is in the hospital and has warfarin on their active medication list, a prompt automatically appears in the EHR when the patient is preparing to go home. The care team is reminded through the prompt to include key information for managing the blood thinning medication — including how long the patient should take the medicine and why, the correct dose, when the next blood test will occur to monitor the thickness of the blood, and who will assume monitoring of the medication after the hospital stay.

“This intervention helps care teams more safely manage a medication with serious side effects through a transition we know to be a high-risk time for medication adverse events: Leaving the hospital. Though we cannot conclude for sure that the intervention causes fewer hospitalizations, there does seem to be an association which is exciting in terms of our patients’ safety.” Day said.

Day came up with the idea during her residency as she often discharged hospitalized patients.

“The intervention is relatively simple,” she said. “It’s a prompt in the electronic health record. It costs nothing to produce other than staff time, effort and collaboration. But there seems to be a big payoff. Avoiding the costs, fear, and inconvenience of a hospital stay is important to patients and their loved ones.”

Day’s findings were published in the 2019 edition of the American Journal of Medical Quality.