Reducing Readmissions for Dehydration Following Ileostomy Surgery

Patients undergoing surgery resulting in a temporary or permanent ileostomy are at higher risk for readmission due to dehydration. In today’s climate of accountable care and pay for performance, all stakeholders are diligently working to reduce readmission rates.   Dehydration may be one of the more preventable complications that result in readmission. Patients with a new ileostomy experience extra challenges. With today’s shorter length of stay, there is less time for teaching and counseling by the Wound, Ostomy, Continence (WOC) nurse.  Discharge preparation includes all aspects of ostomy care with emphasis on dehydration prevention.

OBJECTIVE: The WOC nurse and team at a 600-bed teaching hospital collaborated on a quality improvement project to reduce ileostomy patient readmissions due to dehydration.

Changes to practice include a new written tool-simplifying intake and output data collection post discharge and phone follow up.  Specific output guidelines are explained and included in written discharge materials. Within 48 hours of discharge, the outpatient WOC nurse or other team member makes follow up calls to the patients, and documents findings.

ASSESSMENT: Patient’s compliance to measuring their output varies. Patients report they forget the measuring container and therefore might only record number of times emptying. If the nurse feels the patient is experiencing signs of impending dehydration, additional instructions are given and closer surveillance is initiated. Dehydration prevention also depends on successful pouching because patients experiencing frequent leakages eat and drink less in an effort to stop pouch leakages.  The follow up call includes a query about pouching and any other concerns. For the patient having leakage problems, an outpatient visit with the WOC nurse within 24 hours is offered or phone guidance if a visit is not feasible.  

OUTCOME: This initiative implemented in September 2014 has resulted in a decrease in readmissions due to dehydration.