Anticoagulation Clinic at Zuckerberg San Francisco General is a successful partnership for co-management of patients from the Richard Fine People’s Clinic, other primary care clinics throughout the San Francisco Health Network, and contracted consortium clinics.
Anticoagulant medications are closely monitored and managed by the specially trained clinical pharmacists and nurse practitioner. This practice is also supported by a medical director, especially when clinical decisions involving complex cardiovascular conditions or perioperative anticoagulant administration are needed. ZSFG outpatient specialists communicate regularly with inpatient providers to optimize outcomes when individuals start anticoagulant treatment for the first time, collect data on bleeding and thrombosis events, and establish best practices. Performance improvement and patient safety are core values for the expert licensed professionals on the anticoagulation team. Quality initiatives increased attendance at scheduled appointments, time in therapeutic range (TTR) for individuals treated with warfarin, and appropriate transitions to alternate oral anticoagulants such as rivaroxaban (Xarelto) or apixaban (Eliquis). Surveys indicate a positive patient experience with these high-alert medications, due in large part to point-of-care testing, telephone visits, and streamlined clinic workflows and documentation.