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Lahey Clinic

Lahey Clinic. Hospital-based Outpatient Anticoagulation Clinic. Ann Pianka, MSN. Presented November 4, 2008. The Lahey Approach. Staffing 1 RN: 400 patients; 1 AA: 600 patients Collaborate with the provider already caring for the patient; predominantly a telephone-based service

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Lahey Clinic

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  1. Lahey Clinic Hospital-based Outpatient Anticoagulation Clinic Ann Pianka, MSN Presented November 4, 2008

  2. The Lahey Approach • Staffing • 1 RN: 400 patients; 1 AA: 600 patients • Collaborate with the provider already caring for the patient; predominantly a telephone-based service • Space restrictions • Current Annual Statistics: • >2800 active patients seen annually • ~48,000 INRs managed • > 750 new referrals • Does not include full enrollment of CGP patients: ~1200 additional patients • TTR: 70%; TTR +/- 0.2: 84%

  3. Provider Referrals • Hospital-Based Specialists • Cardiology • Hematology • Surgery • Vascular Medicine • Hospital-Based Primary Care • Community-Based Primary Care*

  4. Challenges in Meeting theStandard of Care • Two different models of care • Specialists managing anticoagulation collaboratively with the ACC • not a comprehensive view of patient risks/needs • Providers not able to keep abreast of changes in clinical guidelines • Difficulty justifying adequate staff to meet the volume • Different models of licensing and re-imbursement • Organizational geography and space limitations

  5. Program Success Tips on Achieving Provider Buy-In Ann Pianka, MSN Presented November 4, 2008

  6. Be Realistic • You can’t fix everything all at once • Too much change can result in chaos if not implemented carefully • Avoid frustration of your staff, providers, patients

  7. Choose your Battles • Identify the areas of highest risk or frustration for your providers in your organization and target those areas first • Referral Process (Closed for 18 months; manual system) • Initiation of Warfarin Protocols (no standard) • Bridging Therapy (High frustration) • Reversal of VKA (no standard) • Dosing Protocols (administrative housekeeping)

  8. Set The Stage • Evaluate your current practice • What works? • What doesn’t? • Provide evidence of the problem • Quality Assurance • Provide information about the Standard of Care • Invoke your experts • Include your users in the needs assessment • Advertise your successes

  9. Make it EASY to Comply • Set up systems that are • easy to access • easy to use • easy to troubleshoot • Set the standard of care and advertise it • Educate your providers of changes in • Practice • Process • Expectations • Utilize a respected Provider Champion • Keep it Simple!

  10. Administration • Has a different perspective on the problem than your providers • If your providers are happy, your administration will be, too! • Be honest in your • Needs • Numbers • Expectations • Do your homework • Advertise your successes

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