ATLANTA – The addition of a comprehensive discharge protocol checklist and follow-up contact for bariatric surgery patients resulted in slightly longer hospital lengths of stay but significant reductions in readmissions.
"I feel the small amount of extra length of stay really supports the 46% overall decrease in readmissions. That’s pretty good," Sharon A. Krzyzanowski, RN, said at Obesity Week, presented by the Obesity Society and the American Society for Metabolic and Bariatric Surgery.
To determine if the addition of discharge protocols had helped their bariatric surgery facility reduce the rate of 30-day readmissions, Ms. Krzyzanowski and her colleagues at the Celebration Health Florida Hospital in Orlando retrospectively analyzed patient data both pre- and post-implementation.
Sharon Krzyzanowski
They compared the data of 224 Roux-en-Y gastric bypass (RYGB) patients before implementation of the protocols to 242 post-protocol RYGB patients; 125 pre-protocol laparoscopic gastric sleeve (LGS) patients to 178 post-protocol patients; and 100 gastric band patients admitted before the center had the protocols in place, vs. 50 such patients after the protocols.
Discharge protocols stipulated that patients must not be in extreme pain and were able to tolerate their pain medication; that they were not nauseous and were able to tolerate their nausea medication; and that they were able to comfortably drink a minimum of 30 ounces on the day of discharge. Respiratory values also had to be at "status quo," said Ms. Krzyzanowski. If patients did not meet any of those protocols, they were not discharged that day.
The second portion of the protocol that the researchers examined was post-discharge patient follow-up, either by phone or by e-mail. Under the protocol, a nurse contacted patients to discuss mental status, medications, postoperative regime, and any other questions the patients might have.
Patient readmissions were sorted according to reasons of technical concern, such as organ injury or leak; physical issues, such as an infection or a thromboembolic event; or general malaise, such as dehydration or benign abdominal pain.
The investigators determined that readmission rates in RYGB patients declined by 38.3%; 34.7% in LGS patients; and 100% in gastric banding patients.
The hospital length of stay in the RYGB group went from a pre-protocol average of 2.12 days to 2.50 days post protocol; in the LGS group, the average length of stay went from 1.93 to 2.10 average days.
The investigators found there was an overall reduction in readmissions of 46%. Readmissions associated with malaise were reduced from 6.5% to 2.9%; those associated with physical concerns were reduced from 2.9% to 2.1%, said Ms. Krzyzanowski. Technical readmissions did not change significantly.
During the question-and-answer portion of the presentation, Ms. Krzyzanowski said in response to a query about reimbursements for keeping patients an extra day, "As long as it’s documented why the patient is staying, insurance will review that and they will be fine. We have not had anybody denied for a third day."
Ms. Krzyzanowski, Dr. Kim, and Dr. Buffington reported no relevant disclosures.