Linda McKenna, MSN, RN, CWOCN, Wound, Skin and Ostomy Services-Nursing Practice and Innovation, University of Wisconsin Hospital and Clinics, Madison, WI, Vera Allyn B. (Lynette) Scott, RN, BSN, COCN, Ostomy Services-Nursing Practice and Innovation, University of Wisconsin Hospital and Clinics, Madison, WI, Tracy Schmotzer, MS, RD, CNSC, Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, WI and Maria Brenny-Fitzpatrick, MSN, FNP-C, GNP-BC, APNP, Transitional Care, University of Wisconsin Hospital and Clinics, Madison, WI
BACKGROUND: Fast-track protocols, expectations of early discharge from the hospital and continuous focus on reducing cost have resulted in decreased lengths of stay (LOS) after colorectal surgeries. However, hospital readmission due to complications is an undesirable outcome of an early discharge program. At our 648-bed, Magnet designated academic center, located in the Midwest, 18.2 percent of the individuals undergoing colorectal procedures resulting in a diverting loop ileostomy were re-admitted within 30 days, many with fluid and nutritional deficits. At our facility, Transitional Care Programs help hospitalized patients transfer in a safe and timely manner to another level of care, such as home or subacute care, yet these programs often focus on individuals with complex medical needs, not post surgical care.
PURPOSE: Incorporate transitional care into our post-operative colorectal Fast Track discharge program and better utilize our registered dietitians, so as to decrease readmission rates for individuals with new loop ileostomies.
METHODS: In addition to standard pre and postoperative education, all Fast Track patients with new loop ileostomies receive counseling from our dietitian to aid in preventing dehydration and blockage. All patients are offered enrollment in the Transitional Care Program and receive a notebook, measuring carafe and instructions for recording specific information, such as food intolerances, intake and output, medication usage, signs or symptoms of dehydration, blockage or ileus and any pouching problems. The Transitional Care nurse communicates with the patient on a daily basis and relays key information to the health care providers (surgeon, home health nurse, certified ostomy nurse)
RESULTS: This collaborative approach has only been utilized for two months, but early data indicates a decrease in readmission rates from 18.2 percent to less than 15 percent.
CONCLUSIONS: Multifaceted programs that target transition of care for individuals with loop ileostomies are successful in decreasing readmission rates.
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