Improving Practice and Reducing Costs with Establishment of an Outpatient Ostomy Service

Janet Ramundo, MSN RN CWOCN CFCN1, Jocelyn Goffney, MSN RN CWOCN1 and Mary Harris, MSN RN2, (1)Center for Professional Excellence, Houston Methodist Hospital, Houston, TX, (2)Houston Methodist Hospital Sugarland, Sugarland, TX
Improving practice and reducing ED hospital costs with establishment of an outpatient ostomy clinic

During 2014, approximately 150 surgeries were performed that resulted in a urinary or fecal diversion in this 918 bed quaternary teaching hospital located in a large metropolitan city.  Care was provided by a team of certified WOC nurses following standards established by the WOCN® Society.1,2,3,4,5

The complication rate for ostomy patients is reported to be as high as 63%.6  Complications result from changes in abdominal contours, parastomal hernias, and mucocutaneous separation4.  Stomal changes are also common following surgery.4    These complications can cause pouch leakage, skin damage and odor issues.

A standard of care established by the WOCN® Society is a recommendation that patients with a new ostomy be provided with a comprehensive discharge plan including resources for support and assistance.1    Unfortunately, many patients did not have access to an ostomy nurse upon discharge from this hospital, and elected to go to the hospital ED for care.   These visits tied up ED staff and were costly to the patient and the hospital. 

An interdisciplinary group was formed to look at the needs of this patient population and consider the feasibility of providing outpatient services to ostomy patients.  The team members developed criteria for outpatient visits and established services in 2014.

A finding associated with clinic establishment was a reduction in ED visits for ostomy related complications.    The average cost of an ostomy related complication was $708; the average cost for the outpatient ostomy visits was $47.   In 2014, 20 patients were seen in the outpatient department, resulting in a savings of $13,220.   Patients and physicians report high satisfaction with this ongoing service, and costly non-emergent ED visits are avoided.