Patient autonomy–centered self-care checklist reduces hospital readmissions after ileostomy creation

Academic Article

Abstract

  • © 2016 Elsevier Inc. Background Patients who undergo a colorectal operation that includes a new ileostomy incur high rates of readmission. Ostomates face a steep learning curve to master the skills and knowledge needed for success at home. We designed and implemented a patient-centered checklist promoting independence and validating self-care knowledge and care skills and evaluated its effect on readmissions after ileostomy creation. Methods On a single inpatient unit, new ileostomy patients were taught and evaluated using a novel postoperative self-care checklist, while perioperative care for ostomates remained unchanged elsewhere in the institution. In a retrospective cohort including all consecutive ileostomy patients from 2 years before (period 1) and 1 year after (period 2) the checklist implementation, we identified univariable predictors of readmission within 30 days of discharge and used a multivariable, difference-in-differences approach to compare trends in readmission between the intervention and control units. Results Of the 430 patients in the study period, there were 116 with readmissions (26%). Readmitted patients had significantly greater all patient refined diagnosis related group weights (3.6 vs 3.3, P = .006) and longer initial duration of stay (13.3 vs 11.3 days, P = .006), and they were more likely to be emergency admissions (49% vs 38%, P = .04). The readmission rate on the intervention unit decreased from 28% in period 1 to 20% in period 2. The logistic regression-based difference-in-differences approach revealed that implementation of the checklist was an independent negative predictor of readmission (P = .04). Conclusion Implementation of a patient-centered, self-care–oriented postoperative education checklist was associated with significantly reduced odds of readmission after ileostomy creation.
  • Authors

    Published In

  • Surgery  Journal
  • Digital Object Identifier (doi)

    Author List

  • Hardiman KM; Reames CD; McLeod MC; Regenbogen SE
  • Start Page

  • 1302
  • End Page

  • 1308
  • Volume

  • 160
  • Issue

  • 5