Decision support tool use in colorectal surgery: what is the role?

Abstract

BackgroundDecision support tools prioritizing transitional care can help decrease medical readmissions but little evidence exists within surgical specialties. Materials and methodsThis study evaluated the use of early screen for discharge planning and discharge decision support system screening tools or selective multidisciplinary clinical evaluation for targeting post-acute care interventions among higher risk colorectal surgery patients based on 30-d readmission status. Patients with positive screening tool scores underwent standard discharge planning education and evaluation during index operation hospitalization and were referred for targeted post-acute interventions; patients with negative screening tool scores were further clinically evaluated for selective referral for post-acute interventions. ResultsWe identified 300 colorectal surgery patients; 30.3% (n = 91) of patients had a positive screening score (early screen for discharge planning and/or discharge decision support system). Positive screening scores did not correlate with hospital readmission (35% of readmitted patients versus 29% of non-readmitted had a positive screen; P = 0.424). After negative screening scores, selective referral based on clinical assessment for postdischarge interventions helped to concentrate resources in patients who were later readmitted. Index hospitalization complications were significantly associated with positive screening tool scores whereas postdischarge complications were most predictive of readmission. ConclusionsAmong colorectal surgery patients, selective clinical referrals appeared to be the best method for targeting post-acute interventions in patients at higher risk for readmission. Future research should focus on improving existing processes of care to reduce postoperative complications and constructing better tools to assess individual patients' needs for targeted interventions in the post-acute setting.