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Augmenting Atrial Fibrillation Care After an Emergency Department Visit

Implementing Telephone Practice

Hart, Danielle RN (EC); Hopman, Wilma M. MA; Hammond, Sharlene BN, RN; Redfearn, Damian P. MD

doi: 10.1097/NCQ.0000000000000381

Background: Between 2010 and 2012, the Heart Rhythm team in a tertiary care hospital completed a retrospective study that found that atrial fibrillation (AF) care can be episodic and heavily reliant on hospital resources, particularly the emergency department (ED).

Problem: Patients who attend the ED with AF are at high risk of hospital admission.

Approach: A nurse practitioner (NP) was added to the Heart Rhythm team to create a program to improve AF care after an ED visit. Telephone practice was one of the many processes created.

Outcomes: Findings revealed that 37 of 90 patients presented to the ED with AF prior to telephone contact and 7 of 90 patients did so post–telephone contact (P < .001).

Conclusion: Telephone practice led by an NP provides an opportunity to improve assessment and management of patient with AF and offers a promising cost-effective method to reduce ED visits in the AF patient population.

Heart Rhythm Service, Queen's University, Kingston, Ontario, Canada (Mss Hart and Hammond and Dr Redfearn); and Kingston General Health Research Institute (KGHRI), Kingston Health Sciences Centre, Kingston, Ontario, Canada (Ms Hopman).

Correspondence: Danielle Hart, RN (EC), Nurse Practitioner, Cardiac Program, Kingston Health Science Center, 76 Stuart St, Kingston, ON K7L 2V7, Canada (

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Accepted for publication: October 21, 2018

Published ahead of print: December 21, 2018

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