A Clinical Network Project Improves Care of Patients with Atrial Fibrillation with Rapid Ventricular Response in Victorian Emergency Departments

Objectives Atrial fibrillation with rapid ventricular response is a common condition in emergency departments (ED) and despite published guidelines, variation in practice is common. The aim of this nine-month evidencebased care improvement project was improving the management of atrial fibrillation with rapid ventricular response (AFRVR). Methods This was a quality improvement project, evaluated using before and after chart review methodology. The outcomes of interest were the proportion of patients managed according to a local treatment pathway, the proportion with duration of symptoms documented, the proportion with rate control versus rhythm control strategy documented and the proportion with a CHADS2 score (or equivalent) documented. Results Ten ED participated. Management according to a local treatment pathway increased from 8% (27/326) of patients to 68% (191/281); p<0.0001. The proportion of patients with symptom duration documented increased from 62% (201/326) to 81% (227/281); p<0.0001. The proportion of patients with CHADS2 score (similar) documented increased from 16% (49/310) to 47% (126/268); p<0.0001. Conclusion This project has led to clinically and statistically significant improvements in management of AFRVR across a health system, although there is still room for improvement. Work continues to embed these gains and make further improvements.