Background: Achieving and maintaining therapeutic anticoagulation with unfractionated heparin in critically ill patients is challenging due to biologic variability, heparin resistance, and limitations of activated partial thromboplastin time (aPTT) monitoring. Argatroban, a direct thrombin inhibitor, provides antithrombin-independent anticoagulation with more predictable pharmacokinetics, but real-world data describing its anticoagulation stability in the intensive care unit (ICU) remain limited. Objective: This study aimed to compare anticoagulation stability between continuous intravenous argatroban and unfractionated heparin in critically ill patients using time in therapeutic range (TTR) based on aPTT as the primary performance metric. Methods: A retrospective cohort study was conducted in the ICU and step-down unit of Hôpital Montfort (Ottawa, ON, Canada) between January 2016 and December 2024. Adult patients receiving continuous intravenous argatroban or unfractionated heparin for systemic anticoagulation were included. All aPTT values obtained during active infusion were extracted, and TTR was calculated using linear interpolation between consecutive measurements. Continuous variables were summarized as medians with interquartile ranges and compared using the Wilcoxon rank-sum test; categorical TTR strata were compared using Fisher’s exact test. Results: Sixty-eight patients met the inclusion criteria, contributing 9 argatroban and 61 heparin infusion courses. Argatroban demonstrated a higher median TTR than heparin (83.3% [IQR 82.0–90.7] vs. 47.5% [32.9–62.4]; p < 0.001), with a moderate-to-large effect size (r = 0.51). Median aPTT values were similar between groups, but argatroban showed narrower dispersion and fewer prolonged subtherapeutic periods. A majority of heparin courses (56.5%) spent <50% of time within range, whereas no argatroban courses fell into this category. Conversely, 33.3% of argatroban courses achieved ≥90% TTR compared with none in the heparin group. Conclusions: In this real-world ICU cohort where argatroban was used for suspected or confirmed HIT, argatroban was associated with higher TTR than unfractionated heparin. These findings support the use of time-dependent metrics to evaluate anticoagulation quality and warrant prospective studies in more homogeneous populations.

Health care innovation is essential for improving patient outcomes, enhancing system efficiency, and preparing for future challenges; however, meaningful progress is often hindered by entrenched barriers such as resistance to change, fragmented interdisciplinary collaboration, and constrained financial and human resources. These persistent obstacles make it difficult for health care systems to translate creative ideas into sustainable, real-world improvements, underscoring the need for structured approaches that support collaboration and reduce implementation friction. To address these challenges, we developed the Actionable Innovation Day (AID) approach, a structured, participatory model designed to generate consensus-based, low-cost recommendations that are feasible for system improvement. The first regional AID event in Eastern Ontario gathered 57 multidisciplinary participants, including clinicians, administrators, patient partners, and industry leaders, for a full-day series of presentations, facilitated discussions, and targeted breakout sessions focused on critical care. Through guided deliberation and collaborative analysis, participants synthesized diverse perspectives into a prioritized set of improvement opportunities. The process yielded 28 actionable recommendations across 4 domains: health care innovation, regionalized care, critical care practices, and the use of artificial intelligence. A postevent survey (86% response rate) showed strong agreement, with 23 recommendations rated above 4 on a 5-point scale. The highest-ranked proposals emphasized the value of strengthening research-industry-clinical partnerships, integrating families more intentionally into intensive care unit rehabilitation and recovery processes, and implementing centralized regional coordination to optimize critical care capacity. Together, these findings illustrate not only the feasibility of the AID model but also the AID model’s ability to surface strategic, context-appropriate solutions that resonate across stakeholder groups. The AID process offers a scalable and adaptable template for advancing health care innovation through collaborative, real-world problem-solving. While this initial event focused on critical care, the underlying principles of structured engagement, iterative consensus building, and interdisciplinary co-design are broadly applicable to many sectors of health care. We encourage institutions, regional networks, and health system leaders to adopt and tailor the AID framework to their own local priorities, recognizing that inclusive innovation processes can accelerate system improvement even in resource-limited settings. Ultimately, the AID approach serves as both a methodology and a call to action: by empowering teams to collectively identify, refine, and champion actionable ideas, health care organizations can build the capacity and culture necessary to drive meaningful and sustained innovation across diverse clinical and operational domains.