Policy, Payment & Practice -> Clinical Quality Measures and Outcomes D-PO03 - Poster Session III (ID 48) Poster

D-PO03-122 - Feasibility Of A Perioperative Atrial Fibrillation Management Protocol For Noncardiac Surgery Patients (ID 332)

 S. Keen: Nothing relevant to disclose.


Background: Perioperative atrial fibrillation (AF) after non-cardiac surgery and has been associated with higher resource utilization, increased hospital length-of-stay, and increased morbidity and mortality. Prior studies have demonstrated the effectiveness of standardized AF management protocols in the emergency department and outpatient endoscopy settings. At the same time, data also show that impact of clinical decision aids may be limited by provider utilization and perceived usefulness.
Objective: To determine the use and feasibility of a guideline-based clinical decision aid for the management of perioperative AF in patients on noncardiac surgical services in an academic hospital and its effect on provider level of comfort.
Methods: Consecutive adult patients admitted to non-cardiac surgical services at a single academic center with an episode of AF or atrial flutter (AFL) were reviewed. In December 2017, a guideline-based protocol for perioperative management of AF and AFL was implemented. A survey evaluating use and perception of the protocol was distributed to surgical providers before and after implementation. Outcomes including length of stay, frequency of rate control (<110 beats per minute) and/or conversion to normal sinus rhythm were also reviewed.
Results: Groups 1 and 2 included 49 and 44 patients, respectively. Following implementation of the protocol, 62.5% (20 of 32) of surgical providers reported protocol use with 75% of those providers rating the protocol as “very helpful” and 25% “somewhat helpful.” No provider responded that the protocol was “not helpful.” Additionally, providers reported a significant improvement in subjective efficiency (p=0.008) and confidence levels (p=0.050) when managing perioperative AF. There were no significant differences in measured outcomes, however, during the pilot period.
Conclusion: Implementation of a perioperative AF management protocol among noncardiac surgical patients improved provider confidence and perceived efficiency when managing AF with a 63% utilization rate. While no significant improvement in patient outcomes was shown in our 3-month pilot, one-year results will provide additional information regarding the effectiveness of the protocol.