Lakeland, Fla.-based Watson Clinic has turned the delicate dosage management of blood-thinning drugs into a safer and less time-consuming process by launching a computer-based anticoagulation clinic.
Before last year, Watson's 180 physicians monitored patients' blood-coagulation rates and dosages of blood-thinning drugs, or anticoagulants, on an individual basis, which required constant doctor-patient interaction.
"On a per-month basis, our physicians could be monitoring 1,300 to 1,600 patients," said Robert Chapman, M.D., medical director of Watson, which has 15 satellite clinics. "Based on five to 10 minutes per patient, a physician could have 40 patients and spend 400 minutes."
Now registered nurses at Watson have taken over monitoring patients' coagulation levels and drug dosage using a computer software system and national guidelines for anticoagulant administration.
Anticoagulants are used to regulate blood clotting. Patients with serious heart or blood-vessel problems tend to develop blood clots, which could result in increased risk of heart-rhythm disorders, stroke or clots in the lungs. The proper dosage for an anticoagulant depends on a patient's level of blood coagulation.
"If patients take too much medication, they are at risk for (internal) bleeding," Chapman said. "If they take too little (anticoagulant), they are at risk for clots. The patient has to be monitored at least once a month."
After national guidelines for the administration of warfarin, a commonly used anticoagulant, were published in 1994, Watson physicians decided to use them as a catalyst for change. Internal studies conducted in 1992 and 1993 showed an overwhelming variation in Watson physicians' dosage decisions.
"It's so critical that you reach these patients to make sure the dosage is correct," Chapman said.
Watson's physicians and nurses thought there was a significant chance for errors.
"We had established very specific protocols about what the treatment would be, what the dosage would be," said Heather O'Connor, director of clinical services at Watson.
In hopes of finding a less cumbersome way to care for these patients, Watson created a computer-based anticoagulation clinic last year. At the new clinic, two nurses and a data-entry technician use software to monitor patients' anticoagulation therapy. The new clinic is based at Watson and is on line to its 15 satellites.
The software, known as CoumaTrac and manufactured by DuPontPharma, documents a patient's laboratory history, interacting medications and current doses. A nurse tracks the patient's coagulation level each month and bases drug dosage on the national guidelines, O'Connor said. Physicians are consulted only when necessary, allowing them to concentrate on other patient needs.
"Patients get better service and more timely notification," Chapman said. "Physicians are free from a very time-consuming process and can be free of the responsibility."
This year, Watson projected savings of $184,000 from the new program. Since the patients are nearly all fee-for-service, the anticoagulation clinic is expected to add nearly $25,000 in annual revenues from Medicare and commercial insurers. Meanwhile, annual costs to operate the anticoagulation clinic are about $100,000.
Watson, which has 500,000 patient visits annually, expects to earn about $110,000 each year from the anticoagulation clinic. Watson's 1995 revenues were about $100 million.
The success of the clinic is drawing the attention of healthcare organizations around the country. "One of our nurses will be serving on a national task force, and we are getting visits from other organizations that are interested in setting up their own clinic," Chapman said.