A Novel Approach at Reducing Avoidable Post-Bariatric Surgery ER Visits and Readmissions

Van S Leavitt, DO, David Podkameni, MD, Flavia Soto, MD, Albert Chen, MD, Emil Graf, MD, Jill Gorsuch, DO, MPH, Sarah Whitehead. Banner Gateway Medical Center

INTRODUCTION: Emergency room (ER) visits and hospital readmissions after bariatric surgery are estimated by the American College of Surgeons to be 5.22%.  Many of these ER visits and readmissions are potentially avoidable with close post-operative monitoring and follow up.  In an effort to reduce postoperative readmission rates at one community center of excellence, a program of frequent post-op phone calls has been employed.  Patients are called every other day for the first two weeks following bariatric surgery and are asked a series of questions addressing early warning signs of potential readmission.  The aim is to reduce avoidable ER visits and readmissions through a telephone triage system.

METHODS AND PROCEDURES: Since March of 2015, patients undergoing bariatric procedures were placed on a call list and contacted by one of the bariatric surgeons every other day for the first two weeks following surgery.  A standard list of questions is asked which addressed the most commonly identified reasons for hospital visit after surgery.  Recommendations are made, questions addressed and reassurance is given to the patients.  In the period of time from March 2015 until August 2015, 160 bariatric procedures were performed mostly consisting of Roux-en-Y gastric bypass and laparoscopic vertical sleeve gastrectomies.  The rate of ER visits and readmissions, which is closely tracked by the institution, was compared to those from exactly one-year prior.

RESULTS: A retrospective analysis of the bariatric surgery database between March and August of 2014 showed that the number of bariatric procedures performed was 152.  The number of ER visits after surgery in 2014 was 15.  This results in a 9.8% ER/readmission rate at this institution.  In 2015 with 160 cases done and 16 ER/readmissions, the rate climbed to 10%.  One patient in the 2015 data accounted for 3 separate ER visits despite multiple phone conversations.  When this patient’s data is added as one occurrence the percentage falls to 8.75%.  The nature of the ER visits did not change significantly with non-specific abdominal pain being the leading cause of ER visitation.

CONCLUSIONS: As the health care system increasingly scrutinizes surgeons and their patient outcomes it behooves us to find new methods for triaging patients and addressing their concerns in an outpatient setting.  While the data from this institution is not demonstrating considerable change currently, it is felt that over time the frequent contact will help decrease the need for patients to seek post-operative care in the ER.

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