Improvement in documentation rates for resumption of antithrombotic agents after elective endoscopy using an electronic health record–based intervention

iGIE Pub Date : 2025-06-01 DOI:10.1016/j.igie.2025.03.004

Jeffrey Than MD , Terrance Rodrigues MD , Mary Kwasny PhD , Srinadh Komanduri MD

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引用次数: 0

Abstract

Background and Aims

Resumption recommendations for anticoagulants (ACs) and antiplatelet agents (APAs) after endoscopy are inconsistently documented, which has been associated with a small but clinically significant number of adverse events (AEs). Clinical decision support systems must be implemented properly to ensure high adoption and clinically appropriate use. This study aimed to improve the rate of documentation of resumption recommendations for ACs and APAs using an electronic health record–based intervention integrated into the existing clinical workflow.

Methods

We implemented a soft-stop endoscopy software alert to trigger if resumption recommendations were not initially documented in patients on ACs and APAs. The rates of documentation of resumption recommendations were compared between pre- and postintervention periods.

Results

Across 1238 encounters for elective outpatient endoscopy, there was no difference in AC and APA use between pre- and postintervention periods. More endoscopies were performed in patients taking ACs (77.9%) compared with those taking APAs (25.3%). The intervention led to a significant increase in documentation of resumption recommendations postintervention from 47.1% (95% confidence interval [CI], 42.6-51.6) and 41.6% (95% CI, 34.1-49.6) to 70.5% (95% CI, 66.3-74.4; P < .001) and 73.1% (95% CI, 65.6-79.4; P < .001) in patients on ACs and APAs, respectively. Patients who were older, undergoing colonoscopy, or female were more likely to have documentation of recommendations, whereas those undergoing endoscopic ultrasound (EUS) or endoscopic retrograde cholangiopancreatography (ERCP) on ACs were less likely to have recommendations documented. Sedation type and the presence of a fellow did not impact documentation rates.

Conclusions

Implementing an electronic health record–based intervention into the existing endoscopy workflow improved the documentation of resumption recommendations for antithrombotic medications after elective outpatient endoscopy.

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使用基于电子健康记录的干预改善选择性内窥镜检查后恢复抗血栓药物的记录率

背景和目的内窥镜检查后抗凝血剂（ACs）和抗血小板药物（APAs）的恢复建议不一致，这与少量但临床显着的不良事件（ae）相关。临床决策支持系统必须正确实施，以确保高采用率和临床适当使用。本研究旨在通过将电子健康记录为基础的干预措施整合到现有的临床工作流程中，提高ACs和APAs恢复建议的记录率。方法：我们实施了软停止内窥镜检查软件警报，如果ACs和APAs患者最初没有记录恢复建议，则触发该软件。在干预前和干预后期间比较恢复建议的文件率。结果在1238例选择性门诊内窥镜检查中，干预前后AC和APA的使用没有差异。服用ac的患者（77.9%）比服用APAs的患者（25.3%）进行了更多的内窥镜检查。干预导致干预后恢复推荐的文件显著增加，从47.1%（95%可信区间[CI]， 42.6-51.6）和41.6% （95% CI, 34.1-49.6）增加到70.5% (95% CI, 66.3-74.4；P & lt;.001)和73.1% (95% CI, 65.6-79.4；P & lt;.001)。年龄较大、接受结肠镜检查或女性患者更有可能有推荐文件，而在ACs上接受内窥镜超声（EUS）或内窥镜逆行胆管造影（ERCP）的患者则不太可能有推荐文件。镇静类型和同伴的存在不影响记录率。结论：在现有的内窥镜检查工作流程中实施基于电子健康记录的干预，改善了选择性门诊内窥镜检查后抗血栓药物恢复建议的文件记录。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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iGIE

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