Cancellations and Transfers Related to New-Onset Atrial Fibrillation: An Analysis of Survey and Patient Safety Reporting Data From Ambulatory Surgical Facilities
Keywords:atrial fibrillation, cancellations, transfers, colonoscopy, endoscopy, patient safety
Atrial fibrillation (AF) is a cardiac arrhythmia characterized by an irregular rhythm and often rapid heart rate. People with AF can be symptomatic or asymptomatic and are at increased risk for stroke. In this study, we used two data sources—a survey and Pennsylvania Patient Safety Reporting System (PA-PSRS) reports—to examine new-onset AF in Pennsylvania ambulatory surgical facilities (ASFs). The survey was developed and conducted to learn more about new-onset AF–related cancellations and transfers in Pennsylvania ASFs and to update the Patient Safety Authority ASF Cancellation and Transfer Tracking Tool. The survey response rate was 53.1%, with 50.9% of respondents indicating new-onset AF–related cancellations in the last year. A five-year review of PA-PSRS data revealed an increase in the number of new-onset AF–related cancellation and transfer events that occurred in the last two years. In 70.9% of the reports, patients were 65 years of age and older. A paucity of research on this patient safety issue led us to identify areas for future research.
Centers for Disease Control and Prevention. Atrial Fibrillation: U.S. Department of Health & Human Services. https://www.cdc.gov/heartdisease/atrial_fibrillation.htm. Published 2020. Accessed March 23, 2021.
January C, Wann L, Alpert J, Calkins H, Cigarroa J, Cleveland J, et al. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014;64(21):e1-76. doi: 10.1016/j.jacc.2014.03.022.
Floyd C, Hayes D. Atrial Fibrillation: What’s the Significance? Nurs. 2016;46(1):24-9. doi: 10.1097/01.NURSE.0000475478.90513.66.
Steinhubl S, Waalen J, Edwards A, Ariniello L, Mehta R, Ebner G, et al. Effect of a Home-Based Wearable Continuous ECG Monitoring Patch on Detection of Undiagnosed Atrial Fibrillation: The mSToPS Randomized Clinical Trial. JAMA. 2018;320(2):146-55. doi: 10.1001/jama.2018.8102.
Thrysoee L, Strömberg A, Brandes A, Hendriks JM. Management of Newly Diagnosed Atrial Fibrillation in an Outpatient Clinic Setting—Patient’s Perspectives and Experiences. J Clin Nurs. 2018;27(3-4):601-11. doi: 10.1111/jocn.13951.
Benezet-Mazuecos J, Garcia-Talavera C, Rubio J. Smart Devices for a Smart Detection of Atrial Fibrillation. J Thorac Dis. 2018;10:S3824-27. doi: https://dx.doi.org/10.21037%2Fjtd.2018.08.138.
Williams B, Chamberlain A, Blankenship J, Hylek E, Voyce S. Trends in Atrial Fibrillation Incidence Rates Within an Integrated Health Care Delivery System, 2006 to 2018. JAMA Netw Open. 2020;3(8):1-12. doi: 10.1001/jamanetworkopen.2020.14874.
Freedman B, Potpara T, Lip G. Stroke Prevention in Atrial Fibrillation. Lancet. 2016;388(10046):806-17. doi: https://doi.org/10.1016/S0140-6736(16)31257-0.
Sanna T, Diener H, Passman R, Di Lazzaro V, Bernstein R, Morillo C, et al. Cryptogenic Stroke and Underlying Atrial Fibrillation. N Engl J Med. 2014;307:2478-86. doi: 10.1056/NEJMoa1313600.
Turunen E, Miettinen M, Setala L, Vehvilainen-Julkunen K. Financial Cost of Elective Day of Surgery Cancellations. J Hosp Admin. 2018;7(6):30-6. doi: 10.5430/jha.v7n6p30.
Medical Care Availability and Reduction of Error (MCARE) Act, Pub. L. No. 154 Stat. 13. 2002.
Turakhia M, Shafrin J, Bognar K, Trocio J, Abdulsattar Y, Wiederkehr D, et al. Estimated Prevalence of Undiagnosed Atrial Fibrillation in the United States. PLoS One. 2018;13(4). doi: https://doi.org/10.1371/journal.pone.0195088
United States Preventive Services Task Force. Screening for Atrial Fibrillation With Electrocardiography: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;320(5):478-84. doi: 10.1001/jama.2018.10321.
Du X, Dong J, Ma C. Is Atrial Fibrillation a Preventable Disease? J Am Coll Cardiol. 2017;69(15):1968-82. doi: 10.1016/j.jacc.2017.02.020.
Miller J, Aronis K, Chrispin J, Patil K, Marine J, Martin S, et al. Obesity, Exercise, Obstructive Sleep Apnea, and Modifiable Atherosclerotic Cardiovascular Disease Risk Factors in Atrial Fibrillation. J Am Coll Cardiol. 2015;66(25):2899-906. doi: 10.1016/j.jacc.2015.10.047.
Samol A, Masin M, Gellner R, Otte B, Pavenstadt H, Ringelstein E, et al. Prevalence of Unknown Atrial Fibrillation in Patients With Risk Factors. Europace. 2013;15:657-62. doi: 10.1093/europace/eus366.
Fitzmaurice D, Hobbs F, Jowett S, Mant J, Murray E, Holder R, et al. Screening Versus Routine Practice in Detection of Atrial Fibrillation in Patients Aged 65 or Over: Cluster Randomised Controlled Trial. BMJ. 2007;335(7616):1-6. doi: 10.1136/bmj.39280.660567.55.
Reddy V, Taha W, Kundumadam S, Khan M. Atrial Fibrillation and Hyperthyroidism: A Literature Review. Indian Heart J. 2017;69:545-50. doi: 10.1016/j.ihj.2017.07.0040019-4832/.
Chen L, Chung M, Allen L, Ezekowitz M, Furie K, McCabe P, et al. Atrial Fibrillation Burden: Moving Beyond Atrial Fibrillation as a Binary Entity: A Scientific Statement From the American Heart Association. Circulation. 2018;137:e623-44. doi: 10.1161/CIR.0000000000000568.
Tedrow U, Conen D, Ridker P, Cook N, Koplan B, Mason J, et al. The Long- and Short-Term Impact of Elevated Body Mass Index on the Risk of New Atrial Fibrillation. J Am Coll Cardiol. 2010;55(21):2319-27. doi: 10.1016/j.jacc.2010.02.029.
American Board of Internal Medicine (ABIM). Choosing Wisely: An Initiative of the ABIM Foundation. https://www.choosingwisely.org/. Published 2021. Accessed April 13, 2021.
American Academy of Family Physicians. Choosing Wisely: An ABIM Initiative, American Academy of Family Physicians Twenty Things Physicians and Patients Should Question. https://www.choosingwisely.org/societies/american-academy-of-family-physicians/. Published 2021. Accessed April 13, 2021.
American Academy of Ophthalmology. Choosing Wisely: An Initiative of the ABIM Foundation, American Academy of Ophthalmology Five Things Physicians and Patients Should Question. https://www.choosingwisely.org/societies/american-academy-of-ophthalmology/. Published 2021. Accessed April 13, 2021.
McConnell M, Turakhia M, Harrington R, King A, Ashley E. Mobile Health Advances in Physical Activity, Fitness, and Atrial Fibrillation. J Am Coll Cardiol. 2018;71(23):2691-701. doi: https://doi.org/10.1016/j.jacc.2018.04.030.
Dorr M, Nohturfft V, Brasier N, Bosshard E, Djurdjevic A, Gross S, et al. The WATCH AF Trial: SmartWATCHes for Detection of Atrial Fibrillation. JACC Clin Electrophysiol. 2019;5(2):199-208. doi: https://doi.org/10.1016/j.jacep.2018.10.006.
Kalla M, Fabritz L, Kirchhof P. Smart About Watches: We Need Technical and Biological Validation of Atrial Fibrillation Screening. JACC Clin Electrophysiol. 2019;5(2):209-11. doi: https://doi.org/10.1016/j.jacep.2018.11.018.
Giancaterino S, Hsu J. The Smartwatch Will See You Now. J Am Coll Cardiol. 2018;72(12):1433-4.
Bumgarner J, Lambert C, Hussein A, Cantillon D, Baranowski B, Wolski K, et al. Smartwatch Algorithm for Automated Detection of Atrial Fibrillation. J Am Coll Cardiol. 2018;71(21):2381-8. doi: https://doi.org/10.1016/j.jacc.2018.03.003.
Longino J, Chaddha A, Kalscheur M, Rikkers A, Gopal D, Field M, et al. Impact of a Novel Protocol for Atrial Fibrillation Management in Outpatient Gastrointestinal Endoscopic Procedures: A Retrospective Cohort Study. BMC Cardiovasc Disord. 2018;18(179):1-5. doi: doi.org/10.1186/s12872-018-0915-0.
Gardner LA. Tracking Ambulatory Surgical Facility Cancellations and Transfers: Lessons Learned from an 18-Month Collaboration. PA Patient Saf Advis. 2014;11(3):109-14.
Lau JK, Lowres N, Neubeck L, Brieger DB, Sy SW, Galloway CD, et al. Letter to the Editor: iPhone ECG Application for Community Screening to Detect Silent Atrial Fibrillation: A Novel Technology to Prevent Stroke. Int J Cardiol. 2013;165:193-4. doi: http://dx.doi.org/10.1016/j.ijcard.2013.01.220.
Gardner LA, Bomboy J. Preoperative Screening and the Influence of Cancellations and Transfers: An Ambulatory Surgical Facility Collaboration. PA Patient Saf Advis. 2014;11(1):15-22.
Haufler K, Harrington M. Using Nurse-to-Patient Telephone Calls to Reduce Day-of-Surgery Cancellations. AORN J. 2011;94(1):19-26. doi: 10.1016/j.aorn.2010.12.024.
Lee CM, Rodgers C, Oh AK, Muckler VC. Reducing Surgery Cancellations at a Pediatric Ambulatory Surgical Center. AORN J. 2017;105(4):384-91. doi: 10.1016/j.aorn.2017.01.011.