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We SPY DAWN AC s Efficiencies

Background. Hamilton General Hospital Regional Trauma /Rehabilitation Centre Cardiovascular ProgramThrombosis Clinic Inception- 1974 by Dr. Alexander Graham Turpie Populous: CVA, AF Venous Thromboembolism- PE/DVT Valvular Disease Thrombophilia Wa

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We SPY DAWN AC s Efficiencies

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    1. We “SPY” DAWN AC’s Efficiencies Marlene Robinson, RN, BSCN McMaster University Hamilton General Hospital Thrombosis Clinic October 2010

    2. Background Hamilton General Hospital • Regional Trauma /Rehabilitation Centre • Cardiovascular Program Thrombosis Clinic • Inception- 1974 by Dr. Alexander Graham Turpie Populous: • CVA, AF • Venous Thromboembolism- PE/DVT • Valvular Disease • Thrombophilia • Warfarin: Resistant/Failure/Intolerance

    3. Clinic Orientation

    4. Clinic Organization Card System • limited patient information • duplicate cards being made/transcription errors • storage • lost cards • common phrase within the clinic “ I can’t find Mr. Jones card” • expended energy in tracking unfound cards • filing at days end • cards were colour coded • Research • Peri-Operative Bridging • Out-Patient

    5. Repetitive Behavior • Daily Workload • INR patient dosing prompted by lab notification • Inconsistent patient follow-up • Labor intensive • Organization • Absence of standardized processes for clinic operations • referral process • missed follow up appointments/end of treatment • missed INR’s • Communication • Inability to interface effectively within clinics scope Unaware of our inefficiencies!

    6. Statistical Absence Respectfully; • Clinic/patient TTR best guess • Estimates only • patient indication for OAC/ actively taking OAC • patient alternative use; Sintrom, LMWH’s • overall clinic size • referral process • peri-operative bridging program • research patients • Inability to quantify outcomes data within out-patient population

    7. Enter!!!! Dr. Alex Spyropoulos, MD,FACP Founder, Medical Director Clinical Thrombosis Centre Lovelace Health System Albuquerque, New Mexico Credentials: EXPERIENCED WILLING ABLE

    8. Follow the “New” Leader

    9. A Vision

    10. Emerge from Darkness

    11. Enlightened % Time in Range (TIR) Hamilton CTC (1,811 patient total) 70.4% % Time in Range for All Active Treatment Plans 1.5-2.5 (2.0 Target) 77.5% 2.0-3.0 (2.5 Target) 71.2% 2.5-3.5 (3.0 Target) 63.5%

    12. Awareness % of INR’s >5 and < 1.5 2.0-3.0 (2.5 Target) %<1.5 8.73 %>5 1.25 2.5-3.5 (3.0 Target) %<1.5 2.36 % >5 2.76

    13. “Spying”Our Future • centralized service for disease management • incorporating new anticoagulants (Dabigatran /Apixaban) • educational activities- externships/ medical students • expansion of the anticoagulation clinic • satellite clinics within our city/ province • incorporating special patient populations (RI, obesity, pregnancy etc) • utilizing DAWN AC for world wide benchmarking • performing outcomes research/national registries

    14. HGH-Thrombosis Team Physicians: Dr. Sam Schulman, Dr. Alex Spyropoulos, Dr. John Eikelboom Administrative: Joan Murphy, Brandy Webster, Lynda Hill Out Patient Clinic Staff: Donna Carter, Heather George, Molly Naylor, Trish Bradshaw Bridging Peri- operative/Hospital Staff: Anna Mancuso-Bene, Jennifer Delaney, Joyce Coletti, Deb Magier, Thelma Mendoza, Ellen Nicholson, Christine Cockhill Research Staff: Lisa Rudd-Scott, Michelle Zondag, Erin Jamula

    15. Summation Nature defines Dawn; “ as the time that marks the beginning of twilight before sunrise” HGH -Thrombosis Clinic defines DAWN AC; “as the means of our progression from the darkness of inefficiency towards enlightened clinical anticoagulation management”

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