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Opportunities to Improve Care for Surgery Patients

Opportunities to Improve Care for Surgery Patients Havens and colleagues provide an analysis of readmission rates for patients who have undergone emergent general surgical procedures in the state of California. These data were abstracted from an administrative database and demonstrate strikingly similar results to those reported using the American College of Surgeons National Surgical Quality Improvement Program.1 Overall, about 1 in 20 patients are readmitted, most commonly for surgical site infection (SSI) and gastrointestinal issues. Clearly, the opportunity for surgeons and hospitals to prevent readmission lies first with instituting systemwide bundled interventions to prevent SSIs. Many groups have demonstrated that engaging health care professionals who care for surgical patients during the arc of a hospital admission to institute standard protocols that prevent postoperative infection can quickly rectify high SSI rates.2 Items such as the use of appropriate antibiotics before incision, chlorhexidine washes before surgery, normothermia and euglycemia intraoperatively, clean instrument trays for closing, and patient education, require the buy-in across services and disciplines. However, hospitals can quickly address high SSI rates and prevent the development of SSIs after discharge with these measures. The gastrointestinal causes of readmission include conditions such as ileus, small-bowel obstruction, and dehydration from high ostomy output, and they are more difficult to systematically address. Interventions that provide preoperative patient education and an early follow-up telephone call or postoperative appointment in the clinic can help. Some groups across the country are piloting the use of tablets to visually and verbally communicate with patients from home during the immediate postdischarge period. Further education on diet and the use of pain medications along with simple interventions such as intravenous hydration in the clinic can provide safe care for patients and prevent readmission. This article contributes further evidence that we have a great opportunity to intervene on behalf of our patients and improve their outcomes. While local programs can be instituted to prevent complications and readmissions, the incorporation of electronic health records and the creation of large health systems will facilitate better care for the 15% to 20% of patients who are readmitted to a different hospital. All of the components are in place to make meaningful progress in surgery, and with our leadership, we can realize substantial change and, most importantly, happy healthy patients. Back to top Article Information Corresponding Author: O. Joe Hines, MD, Department of Surgery, David Geffen School of Medicine at University of California at Los Angeles, 10833 Le Conte Ave, 72-180 CHS, Los Angeles, CA 90095-6904 (joehines@mednet.ucla.edu). Published Online: November 11, 2015. doi:10.1001/jamasurg.2015.4062. Conflict of Interest Disclosures: None reported. References 1. Merkow RP, Ju MH, Chung JW, et al. Underlying reasons associated with hospital readmission following surgery in the United States. JAMA. 2015;313(5):483-495.PubMedGoogle ScholarCrossref 2. Keenan JE, Speicher PJ, Thacker JK, Walter M, Kuchibhatla M, Mantyh CR. The preventive surgical site infection bundle in colorectal surgery: an effective approach to surgical site infection reduction and health care cost savings. JAMA Surg. 2014;149(10):1045-1052.PubMedGoogle ScholarCrossref 3. Havens JM, Olufajo OA, Cooper ZR, Haider AH, Shah AA, Salim A. Defining rates and risk factors for readmissions following emergency general surgery [published online November 11, 2015]. JAMA Surg. doi:10.1001/jamasurg.2015.4056.Google Scholar http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Surgery American Medical Association

Opportunities to Improve Care for Surgery Patients

JAMA Surgery , Volume 151 (4) – Apr 1, 2016

Opportunities to Improve Care for Surgery Patients

Abstract

Havens and colleagues provide an analysis of readmission rates for patients who have undergone emergent general surgical procedures in the state of California. These data were abstracted from an administrative database and demonstrate strikingly similar results to those reported using the American College of Surgeons National Surgical Quality Improvement Program.1 Overall, about 1 in 20 patients are readmitted, most commonly for surgical site infection (SSI) and gastrointestinal issues....
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Publisher
American Medical Association
Copyright
Copyright © 2016 American Medical Association. All Rights Reserved.
ISSN
2168-6254
eISSN
2168-6262
DOI
10.1001/jamasurg.2015.4062
Publisher site
See Article on Publisher Site

Abstract

Havens and colleagues provide an analysis of readmission rates for patients who have undergone emergent general surgical procedures in the state of California. These data were abstracted from an administrative database and demonstrate strikingly similar results to those reported using the American College of Surgeons National Surgical Quality Improvement Program.1 Overall, about 1 in 20 patients are readmitted, most commonly for surgical site infection (SSI) and gastrointestinal issues. Clearly, the opportunity for surgeons and hospitals to prevent readmission lies first with instituting systemwide bundled interventions to prevent SSIs. Many groups have demonstrated that engaging health care professionals who care for surgical patients during the arc of a hospital admission to institute standard protocols that prevent postoperative infection can quickly rectify high SSI rates.2 Items such as the use of appropriate antibiotics before incision, chlorhexidine washes before surgery, normothermia and euglycemia intraoperatively, clean instrument trays for closing, and patient education, require the buy-in across services and disciplines. However, hospitals can quickly address high SSI rates and prevent the development of SSIs after discharge with these measures. The gastrointestinal causes of readmission include conditions such as ileus, small-bowel obstruction, and dehydration from high ostomy output, and they are more difficult to systematically address. Interventions that provide preoperative patient education and an early follow-up telephone call or postoperative appointment in the clinic can help. Some groups across the country are piloting the use of tablets to visually and verbally communicate with patients from home during the immediate postdischarge period. Further education on diet and the use of pain medications along with simple interventions such as intravenous hydration in the clinic can provide safe care for patients and prevent readmission. This article contributes further evidence that we have a great opportunity to intervene on behalf of our patients and improve their outcomes. While local programs can be instituted to prevent complications and readmissions, the incorporation of electronic health records and the creation of large health systems will facilitate better care for the 15% to 20% of patients who are readmitted to a different hospital. All of the components are in place to make meaningful progress in surgery, and with our leadership, we can realize substantial change and, most importantly, happy healthy patients. Back to top Article Information Corresponding Author: O. Joe Hines, MD, Department of Surgery, David Geffen School of Medicine at University of California at Los Angeles, 10833 Le Conte Ave, 72-180 CHS, Los Angeles, CA 90095-6904 (joehines@mednet.ucla.edu). Published Online: November 11, 2015. doi:10.1001/jamasurg.2015.4062. Conflict of Interest Disclosures: None reported. References 1. Merkow RP, Ju MH, Chung JW, et al. Underlying reasons associated with hospital readmission following surgery in the United States. JAMA. 2015;313(5):483-495.PubMedGoogle ScholarCrossref 2. Keenan JE, Speicher PJ, Thacker JK, Walter M, Kuchibhatla M, Mantyh CR. The preventive surgical site infection bundle in colorectal surgery: an effective approach to surgical site infection reduction and health care cost savings. JAMA Surg. 2014;149(10):1045-1052.PubMedGoogle ScholarCrossref 3. Havens JM, Olufajo OA, Cooper ZR, Haider AH, Shah AA, Salim A. Defining rates and risk factors for readmissions following emergency general surgery [published online November 11, 2015]. JAMA Surg. doi:10.1001/jamasurg.2015.4056.Google Scholar

Journal

JAMA SurgeryAmerican Medical Association

Published: Apr 1, 2016

Keywords: postoperative complications,patient readmission,postoperative care,surgical procedures, operative,surgical wound infection,surgery specialty,postoperative infections,gastrointestinal complications

References