Online statistical monitoring of critical patient data increases patient safety

In this paper we present an improvement project conducted at a unit responsible for blood thinning treatment at Lidkoping hospital in Sweden. The unit coordinates and monitors the treatment of 1200 patients and consists of a heart specialist and five specially trained nurses. Warfarin is an oral anticoagulant (blood thinning) treatment effective for the prevention and treatment of thromboembolic events in various clinical contexts. The project started in the autumn of 2005 as an effort to improve the safety of patients receiving blood thinning therapy. The aim was to reduce morbidity and mortality of patients undergoing warfarin treatment. Since there is a strong association between individual variation in the International Normalized Ratio (INR) and patient morbidity/mortality in warfarin treatment, the focus of the project was to reduce variation in the INR value of patients undergoing warfarin treatment as a way to eventually decrease mortality and morbidity. In this application, an IT-solution was developed in 2006, where process INR-values are monitored online and visualized in a control chart, available to all co workers in the process. The IT-solution proved to be critical in order to encourage continuous improvement in the process The data are updated on a daily basis, stimulating reflection and daily improvement. Analyzing and learning from the data, special causes of variation in INR-values have been identified and removed from the process. The treatment process is now stable, in statistical control and patient safety has increased. As a result, the number of INR values within therapeutic range (values between 2.0-3.0) per week increased from 63% (autumn 2005) to 66% May 2006 to 70% December 2007 (latest data).