Hiren Shah M.D., MBA – QI is the tool of choice for thrombosis prevention
Medical director, Medicine and Cardiac Telemetry Hospitalist Unit, Northwestern Memorial Hospital
National chair, Clinician Intervention Committee for ACP’s Initiative on Atrial Fibrillation and Stroke Prevention
Director, Society of Hospital Medicine’s National Atrial Fibrillation Initiative
Trend to watch: Promoting stroke and bleed risk assessment at the time of admission or discharge
The other factor is that hospitalists may not communicate in a detailed way with outpatient physicians because they assume this is an outpatient issue. Finally, they may overestimate a patient’s fall risk and not start stroke prophylaxis.
Question: How do you address the time constraints?
Dr. Shah: There is a set number of patients who very clearly would benefit from anticoagulation and for whom the bleed risk would be very low. The discussion with these patients could be quite streamlined because there is such an overwhelming reason to start anticoagulation. There is another group of patients where the balance between risk and benefit is a little bit closer. In those patients, you would certainly need to have a very robust, time intensive discussion.
The solution, however, is that when there are situations that are quite difficult in regard to risk and benefit, the decision does not need to be made by the hospitalist. What we want is to ensure that we have systems in place so that the hospitalist can communicate with the outpatient doctor on the stroke and bleed risk and then that discussion can carry forward into the outpatient environment.
It’s important that we use the hospital as a moment in time where we can make very easy decisions on easy patients and we can communicate the more complex situations to the outpatient doctors so there is a safe, quality-driven care transition.
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