Improving transitions of care for patients taking anticoagulants: a survey study of secondary care healthcare professionals

Abstract Introduction Transitions of care (TOC) refer to the movement of patients between healthcare settings. These transitions increase the risk of adverse events due to potential discrepancies in discharge documentation and miscommunication as responsibility shifts between settings.1 For patients on anticoagulants, this risk is particularly high, with potential for bleeding or thrombotic complications, underscoring the need for structured anticoagulation management. Despite this, limited consensus exists on best practice during TOC, highlighting the importance of understanding current processes and barriers. Aim To capture healthcare professionals’ perspectives on anticoagulant management during transitions into and out of acute hospital care and to identify associated challenges and potential strategies and recommendations for addressing these barriers. Methods An online survey, informed by a review of the literature and piloted with a haematologist and pharmacist, was distributed via email to physicians, nurses, and pharmacists across three hospitals in November 2024. The survey included four sections: demographics; current practices and challenges; potential solutions; open-ended questions. One item addressed the ACDC list (Anticoagulation Communication at Discharge), a set of 15 requisite data elements (RDEs) established by an international expert group.2 Quantitative data were analysed descriptively; qualitative responses underwent thematic analysis. Response rate could not be calculated as the number of recipients was unknown. Results Sixty-nine HCPs (20 physicians (29%), 21 pharmacists (30%), 28 nurses (41%)) participated. Participants were highly experienced, with 64% reporting 10+ years in practice. They represented a broad range of clinical areas, most commonly cardiology (13%), care of the older person (13%), acute medicine (12%), and general surgery (10%). The most frequently encountered challenges were lack of communication between care settings (37%) and medication discrepancies (e.g. dosage errors) (28%). Medication discrepancies were reported more frequently by pharmacists than other HCPs. Over half of participants, 54%, felt that communication was insufficient during TOC. The three key barriers identified were (i) inadequate handover procedures, (ii) limited staffing resources, and (iii) time constraints. The three strategies identified as most effective for improving anticoagulant management were (i) improved communication tools (electronic health information), (ii) standardised handover procedures for anticoagulants, and (iii) clearer guidelines for anticoagulant management. While all 15 RDEs were selected by at least some participants, over 90% agreed that the following items are essential for inclusion on the discharge prescription of an anticoagulated patient: the anticoagulant prescribed, clinical indication, whether treatment is acute or chronic, and for patients on warfarin, the target INR/therapeutic range. Conclusion Safe TOC is a priority in the WHO Patient Safety Action Plan (2021–2030). International guidance emphasises structured communication and standardised processes to reduce anticoagulant-related harm, yet implementation remains challenging. Findings from this study align with previous evidence highlighting persistent communication failures and the need for system-level solutions to support safe anticoagulation management across settings. Strengths of this study include multidisciplinary input across three hospitals; however, the small sample size may limit generalisability. Addressing identified barriers offers an opportunity to optimise anticoagulant management and reduce preventable harm. These insights reinforce the need for coordinated approaches to ensure safer, seamless TOC for anticoagulated patients.