Patient autonomy–centered self-care checklist reduces hospital readmissions after ileostomy creation

Abstract

Background Patients who undergo colorectal surgery with new ileostomies incur high rates of readmission. Ostomates face a steep learning curve to master the skills and knowledge needed for success at home. We designed and implemented a patient-centered checklist promoting independence and validating self-care knowledge and care skills, and evaluated its effect on readmissions after ileostomy creation. Methods On a single inpatient unit, new ileostomy patients were taught and evaluated using a novel postoperative self-care checklist, while perioperative care for ostomates remained unchanged elsewhere in the institution. In a retrospective cohort including all consecutive ileostomy patients from two years before (Period 1) and one year after (Period 2) checklist implementation, we identified univariable predictors of readmission within 30 days of discharge and used a multivariable, difference-in-differences approach to compare trends in readmission between the intervention and control units. Results Of the 430 patients in the study period, there were 116 with readmissions (26%). Readmitted patients had significantly higher All Patient Refined-Diagnosis Related Group weights (3.6 vs. 3.3, p=0.006), longer initial length of stay (13.3 vs. 11.3 days, p=0.006) and were more likely to be emergency admissions (49% vs. 38%, p=0.04). The readmission rate on the intervention unit decreased from 28% in Period 1 to 20% in Period 2. The logistic regression-based difference-in-differences approach revealed that implementation of the checklist was an independent negative predictor of readmission (p=0.04). Conclusion Implementation of a patient-centered, self-care oriented postoperative education checklist was associated with significantly reduced odds of readmission after ileostomy creation in colorectal surgery.

A literature review about self‐care on ostomy patients and their caregivers

“…Overall incidence rates of complications vary from 21% to 60%. 21 Understanding long-term and persistent ostomy-specific concerns and adaptations in CRC survivors can provide information for developing comprehensive supportive care strategies for this understudied cancer population.…”

“…7 There is growing interest in promoting stoma self-care efficiency to fight common challenges associated with ostomy creation. 21…”

Patients’ and healthcare workers’ recommendations for a surgical patient safety checklist – a qualitative study

“…With patient compliance, these programs have shown reductions up to 50% in complications, and 42% in mortality in patients [7,19]. Further, one study having designed and implemented a patient checklist after colorectal surgery showed reduction of readmissions from 28% to 20% [16]. These findings might indicate that introducing a patient checklist before and after surgery can inform patients better about what they can do to prevent complications and enhance their safety knowledge.…”

“…Systematic literature reviews on patient involvement in safety show that patients have an important role on their own safety, but evidence on effects of such involvement is limited [3,11,12]. There have been numerous attempts to facilitate use of patient-centred checklist pamphlets and apps [13][14][15][16]. These tools are often not aligned with different hospital administrative systems and the patients' medical records, limiting their potential as communication tools to prevent errors [17].…”

Checklist in colorectal surgery – proposal of experts of the Polish Club of Coloproctology and National Consultant in general surgery

“…the list developed by Sullivan and Castleberry [8,9]. Also, checklists developed for postoperative patient education can lead to a significant re-admission rate reduction in patients with ileostomy [10].…”