Opportunities to Improve Care for Surgery Patients.

Abstract

Havensandcolleaguesprovideananalysisof readmissionrates 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, theopportunity for surgeons andhospitals toprevent readmission lies first with instituting systemwide bundled interventions toprevent SSIs. Many groups have demonstrated thatengaginghealthcareprofessionalswhocare for surgical patients during the arc of a hospital admission to institute standardprotocols that prevent postoperative infection can quickly rectify high SSI rates.2 Items such as the use ofappropriateantibioticsbefore incision,chlorhexidinewashes 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 dischargewith thesemeasures. 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 visuallyandverballycommunicatewithpatients fromhomeduring the immediatepostdischargeperiod.Further educationon diet and the use of painmedications 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 systemswill facilitate better care for the 15% to 20%of patients who are readmitted to a different hospital. All of the components are in place tomakemeaningful progress in surgery,andwithour leadership,wecanrealizesubstantial change and, most importantly, happy healthy patients.