Brigham and Women’s AMS started in December 1996 under the management of Medical Director, Dr. Samuel Goldhaber, a cardiologist with a specialty in vascular medicine. The original intent of the service was to manage patients enrolled in the Outpatient DVT Study where Dr Goldhaber and his team in the Venous Thrombosis Research Group were studying the impact of using a low molecular weight heparin “bridge” to therapeutic warfarin to treat patients with acute DVT and/or pulmonary embolism in the outpatient setting. At this time all the patients were managed by 3 staff nurses who recorded all warfarin dosages and INRs in a notebook. The RNs would carry around a pager and this notebook 24/7 to facilitate patient care. At this time there were a few hundred patients managed under this model.
The service continued to grow exponentially such that Dr. Goldhaber and his team began a collaboration with the Brigham and Women’s Pharmacy to manage patients under a more formal structure that could support the expansion needed to provide this service to the entire Brigham and Women’s community. During this time the clinic moved to an electronic system to manage and track patient data.
Eventually legislation in Massachusetts allowed for pharmacists to prescribe medications and manage disease states under Collaborative Practice Agreements. The Brigham and Women’s AMS had grown to approximately 4,000 patients at that point and were operating with 2 co-medical directors (Dr. Goldhaber and Dr. Connors, a pharmacy manager, an operations coordinator, 10 pharmacists and 4 pharmacy interns.
Although the clinic began as a warfarin management service, it has grown to what it is today – an anticoagulation management service. In this model each patient has a pharmacist who is primarily responsible for their anticoagulation management and is supported by a pharmacist teammate as well as the other pharmacists in the clinic. The service now manages warfarin along with all the direct-acting oral anticoagulants and provides multiple services to patients and providers alike including 24/7 emergency coverage for bleeding or clotting concerns, peri-procedural management, drug access services, education, adherence coaching and anticoagulation management.
Brigham and Women’s AMS Annual Report Metrics
Brigham and Women’s AMS is committed to continuous quality improvement and optimizing patient care and anticoagulation management. We are proud to be designated an AC Forum Center of Excellence and track our clinical and operational metrics monthly to ensure our quality standards are met. Please see the latest version of our Annual Report.