Transitioning complex wound and high-output enterocutaneous fistula patients from acute care while reducing readmissions

Purpose:  To provide clear and simple discharge instructions for wound and fistula patients transitioning from acute care to home or long-term care facilities. 

Clinical Problem:  This 525-bed acute care hospital had frequent readmissions of patients with complex wounds and high output fistulas due to complications. These patients would have prolonged hospitalizations and discharge planning was difficult. Care was performed by the WOC RN due to the complexity and their specific needs. Generic discharge instructions were not beneficial to the Home Care or long-term care clinician. These patients would return within several days or weeks due to wound infection, peristomal skin breakdown, or due to not having appropriate supplies.

Methods: Upon identifying patients with complex wounds and high output fistulas, the WOC RN would work with the staff in obtaining appropriate products and treating complications. Once an appropriate treatment plan was proven to be beneficial, the WOC RN would create patient-specific skin and wound care instructions. This included step-by-step instructions with pictures, company and product information, along with equivalent products. These instructions would be provided as a supplement upon discharge. Additional supplies were also sent with the patient.

Outcomes: 3 cases: 45-year old woman with 5 Stage 4 pressure injuries requiring NPWT – readmitted monthly for 3 months, 45-year old male with high output fistula requiring extensive pouching – readmitted 3 times within 6 months, and a 62-year old female with high output fistula requiring extensive pouching – readmitted 5 times within 8 months.

Patient-specific skin and wound care instructions were provided upon discharge resulting in significant reduction in readmission. The 45-year old female is now maintained in the home and wounds are no longer infected, the 45-year old male is maintained in the skilled nursing facility, and the 62-year old female is being scheduled for closure of the enterocutaneous fistula.