P. D. Henry1, A. W. Trickey1, M. W. Laporta2, K. A. Matzie1, C. Allred1, L. Dougherty1 1Inova Fairfax Hospital,Department Of Surgery,Falls Church, VA, USA 2Thomas Jefferson University,Division Of Acute Care Surgery, Department Of Surgery,Philadelphia, PA, USA
Introduction: Patients with new ileostomies face numerous physiological and psychological challenges ranging from dehydration that can cause acute renal failure to difficulties with stoma care. Despite resources to educate and support these patients, the hospital readmission rate for new ileostomies is high. This project aimed to study the impact of an integrated care delivery model for patients undergoing ileostomies at a large teaching hospital. We implemented a new ileostomy protocol to improve patient care outcomes and evaluated 30-day readmission rates due to dehydration before and after implementation.
Methods: The ileostomy protocol, which provides comprehensive ileostomy care education to patients and the entire clinical care team, was a collaborative effort created by a multidisciplinary committee. Initial education began at the pre-operative visit with the surgeon and outpatient ostomy nurse. A standardized pain, fluid, and diet regimen was implemented post-operatively (per standard hospital Enhanced Recovery After Surgery protocol). Early patient participation in stoma management and patient’s comfort by discharge were ensured. Upon discharge, patients were given logs to record their daily weights, intake, and output, as well as education materials outlining when to call the office with concerns about dehydration. High-risk patients were identified and their instructions modified accordingly. Patients were set up with visiting nurses who had also been educated on the protocol. On home day 3, patients communicated by phone with an office nurse to review overall status and logs of weights, intake, and output. Dehydration-related readmissions within 30 days of hospital discharge were identified based on diagnosis codes and tracked from 24 months prior to implementation of the protocol. Spearman rank correlation was calculated to analyze trends in percentage of ileostomy patients with 30-day dehydration readmissions over 6 month intervals.
Results: A total of 153 ileostomy patients were included in the analysis (78 prior to initial protocol introduction, 75 following protocol introduction). The percentage of patients readmitted with dehydration significantly decreased over time (Spearman’s rho=-0.86, p=0.0137).
Conclusion: A multidisciplinary protocol for new ileostomy patients that includes pre-operative education, standardized pain, fluid, and diet regimens, active in-hospital patient participation, and post discharge tracking of intake and output with close follow up is effective in decreasing 30-day hospital readmission rates. Similar clinical protocols may be generalizable to other types of complex abdominal surgery.
