Conference article

Improving Warfarin Treatment

Svante Lifvergren
Hospital Group of Skaraborg, Sweden

Alexander Chakhunashvili
Hospital Group of Skaraborg, Sweden

Bo Bergman
Chalmers University of Technology, Sweden

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Published in: 10th QMOD Conference. Quality Management and Organiqatinal Development. Our Dreams of Excellence; 18-20 June; 2007 in Helsingborg; Sweden

Linköping Electronic Conference Proceedings 26:32, p.

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Published: 2008-02-15


ISSN: 1650-3686 (print), 1650-3740 (online)


Warfarin is an oral anticoagulant (blood thinning) medication effective for the prevention and treatment of thromboembolic events in various clinical contexts; see Hylek and Singer (1994); Cannegieter et al. (1995); Odén and Fahlén (2002) and Levine et al. (2004) for more information about warfarin treatment. Since it is an extremely safety-critical medication; patients undergoing warfarin treatment should be monitored frequently by blood testing to ensure that the treatment yields desired results.

There are about 100 000 patients (approximately one percent of the total population) treated using anticoagulant medications such as warfarin today in Sweden. The proportion of older patients (over 80 years old) has increased over the past decade and today it accounts for approximately 30 percent; see Läkemedelsverket (2006). There are reasons to believe that both the proportion of patients undergoing warfarin treatment and proportion of older patients will continue to increase at the same time as alternative treatment methods; possibly replacing warfarin do not seem to appear in the near future.

The improvement project presented in this paper was conducted at a unit responsible for warfarin treatment at Lidköping hospital in Sweden. The unit coordinates and monitors the warfarin treatment of 1200 patients and consists of a cardiologist and five specially trained nurses. Lidköping hospital is situated in the Western Region of Sweden and is one of the four hospitals in the Skaraborg Group of Hospitals. It serves a population of around 85 000; and is an acute hospital having complete departments and with staff on-call. The care offered includes; among others; internal medicine; surgery; urology; orthopaedics; gynaecology and paediatrics. In total there are more than 160 beds and around 700 employees.

In the following sections we will provide the background of the study including the outline and context of the problem; assessment of the problem and strategy for change including the approach taken and recommendations proposed. Finally; we present the results of the study and elaborate on some of the lessons learned.


Warfarin treatment; INR; Six Sigma; process improvement


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