کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
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5734742 | 1411840 | 2016 | 7 صفحه PDF | دانلود رایگان |
BackgroundPatients who undergo a colorectal operation that includes a new ileostomy 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.MethodsOn 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 2Â years before (period 1) and 1Â year after (period 2) the checklist implementation, we identified univariable predictors of readmission within 30Â days of discharge and used a multivariable, difference-in-differences approach to compare trends in readmission between the intervention and control units.ResultsOf the 430 patients in the study period, there were 116 with readmissions (26%). Readmitted patients had significantly greater all patient refined diagnosis related group weights (3.6 vs 3.3, PÂ =Â .006) and longer initial duration of stay (13.3 vs 11.3Â days, PÂ =Â .006), and they were more likely to be emergency admissions (49% vs 38%, PÂ =Â .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 (PÂ =Â .04).ConclusionImplementation of a patient-centered, self-care-oriented postoperative education checklist was associated with significantly reduced odds of readmission after ileostomy creation.
Journal: Surgery - Volume 160, Issue 5, November 2016, Pages 1302-1308