S. Kim1, C. McDavid2, J. Turan2, S. J. Knight2, H. Chen2, S. Bhatia2, C. J. Brown2, C. J. Balentine1 1University Of Texas Southwestern Medical Center,Surgery,Dallas, TX, USA 2University Of Alabama at Birmingham,Birmingham, Alabama, USA
Introduction:
Nearly 50% of patients having abdominal surgery will rely on post-acute care (home health, skilled nursing facilities, or inpatient rehabilitation) to complete their postoperative recovery. The purpose of this study was to explore the patient and caregiver experience with post-acute care after abdominal surgery, to identify areas for improvement that could enhance recovery.
Methods:
We conducted separate semi-structured interviews with 7 patients and 6 caregivers who used home health or skilled nursing facilities following abdominal surgery (pancreatectomy, colorectal resection, or small bowel resection). We also interviewed 8 healthcare providers (2 physicians, 2 social workers, 1 case manager, 2 occupational/physical therapists, and 1 physician assistant).
Results:
Mean patient age was 71 years, with 6 patients receiving home health referrals and 1 discharged to a skilled nursing facility. The mean age of caregivers was 66 years, 67% were women, and 3 were spouses, 2 were children, and 1 was a sibling.
Preoperatively, patients and caregivers felt that their surgeons did an excellent job preparing them for surgery and discussing postoperative complications. However, patients and caregivers reported that surgeons rarely addressed the possibility of needing post-acute care and how this could affect patients and caregivers. Postoperatively, patients and caregivers struggled with selecting which home health company or skilled facility should provide their post-acute care, because they lacked information on how to compare the quality of the different providers or facilities. Healthcare providers struggled with recommending which home health companies or skilled facilities would be most suitable for each patient. Most providers lacked information on the quality of facilities or home health, and others felt uncomfortable telling patients which facilities/companies might provide poor quality services.
Most patients and caregivers had a positive experience with post-acute care and were grateful for ongoing assistance with rehabilitation, ostomy management, and coordination of care with their surgeons. Criticisms of post-acute care services were generally limited to poor communication about the goals of care, and concerns about the timing or intensity of treatment.
Conclusion:
A preoperative discussion about the potential need for post-acute care in high risk patients could help patients and their caregivers prepare for the realities of recovery from complex surgery. A better process for helping patients to choose among the different home health companies and skilled facilities that offer post-acute care services could also improve outcomes by ensuring that patients are able to select the provider or facility that offers the best care to address their postoperative recovery needs. In particular, the surgical team would benefit from education about available services and how to counsel patients when making decisions about post-acute care placement.