Let’s Gut Together: Coordinated Care of New Ostomates

Purpose: Care for new ostomy patients is complex and requires a multidisciplinary approach. To facilitate positive patient outcomes, new ostomy patients require collaboration between inpatient and outpatient care teams. This partnership is especially essential during the index hospitalization. Without this approach, poor patient outcomes can result. The Centers for Medicare and Medicaid Studies (CMS) and the National Surgical Quality Improvement Program (NSQIP) have specified colorectal surgery outcomes among the top five specialties for improvement (Fish et al., 2017). In addition, patients with a urostomy require a significant amount of care and education both short-term and long-term (Bearti-Hearn, 2019).
Description: A team of 21 inpatient and outpatient staff collaborated from April 2021 to October 2022 to develop standard operating procedures (SOP) streamlining care of new ostomy patients across the care continuum. The SOP detailed roles and responsibilities of the care team from post-operative days 0-5. Prior to implementation, the team identified that all wound/ostomy/continence (WOC) RNs and RNs on the inpatient complex abdominal surgery unit needed ostomy care education. In addition, an ostomy resource packet was developed. To ensure efforts were patient-centered, a patient-family advisor (PFA) reviewed all materials and provided feedback. The team conducted a 20-week pilot to evaluate outcomes directly influenced by the use of the SOP.
Evaluation/outcome: Data collection included hospital length of stay, readmission data, ED visits, outpatient follow-up compliance, staff competencies, and discharge data. In addition, compliance with the standard work/SOP toolkit was monitored. During a five-month pilot, the interdisciplinary group met biweekly to monitor adherence to the standard operating procedures and tracked quality metrics. 32 patients were included in the pilot. Their average length of stay was 11 days. Nine patients (28%) had ED visits within 90 days of discharge. Same-day add-on appointments decreased for the urostomy patients. Eleven patients readmitted within 90 days of discharge. Seven admissions were ostomy-related. 88% (n=28) of patients had WOC RN appointments after discharge. 72% (n=23) of patients had WOC appointments within 14 days of discharge. A post-hospital survey showed discharged patients referred to the ostomy resource packet at least once. 72% (n=23) of patients received 30-days’ worth of supplies at discharge. Improvements in discharge times was noted for patients with urostomies. All WOC and staff RNs on the inpatient unit completed ostomy training and demonstrated competency. 56% (n=18) of patients experienced home health arrangement issues due to staffing. Since the pilot, 90-day readmission rates and 90-day ED visits have improved for all ostomy populations. There were challenges getting patients to watch ostomy educational videos while inpatient. The team also identified that more work is needed to streamline the outpatient appointment scheduling process.
References
1) Bearti-Hearn, L., Elliott, B. (2019). Urostomy care: A guide for home care clinicians. Home Health Care Now, 37(5), 248-255. https://journals.lww.com/homehealthcarenurseonline/Fulltext/2019/09000/Urostomy_Care__A_Guide_for_Home_Care_Clinicians.2.aspx
2) Fish, D. R., Mancuso, C.A., Garcia-Aguilar, J. E., Lee, S. W., Nash, G. M., Sonoda, T., Charlson, M. E., Temple, L. K. (2017). Readmission after ileostomy creation: Retrospective review of a common and significant event. Annals of Surgery, 265(2), 379-387. https://journals.lww.com/annalsofsurgery/Fulltext/2017/02000/Readmission_After_Ileostomy_Creation_.22.aspx