Christy Y Chai, MD1, Elaine Vo, MD2, Celia Robinson, MD3, Aanand D Naik, MD1, G N Burns, RN1, Nader N Massarweh1, Hop Trancao, MD1, Samir S Awad, MD1. 1Michael E Debakey Veteran Affairs Medical Center, 2Baylor College of Medicine, 3University of Texas MD Anderson Cancer Center
Introduction: A 30-day unplanned readmission has become an important metric for quality of care associated with worse clinical outcomes including increased one year mortality in colorectal cancer (CRC) patients. The Project RED is an evidence based intervention developed in an effort to improve the hospital discharge process and reduce readmission rate in medical patients. The Project RED-S was piloted in our CRC surgery patients to assess its feasibility in surgical patients and to facilitate transition of care from inpatient to outpatient care setting.
Methods: The Project RED-S was piloted in CRC surgery patients treated at our institution from September 2014 to October 2015 with a discharge advocate coordinating discharge plans with the primary team, providing patient education, and creating a patient-centered after-hospital care plan package with instructions at 4th-5th grade reading level, medication reconciliations, and follow-up appointments. A follow-up phone call was made by a nurse within 2-4 days after discharge to review appointments, medications and medical concerns. Retrospectively, we compared demographics and clinical data of the Project RED-S patients to those of CRC surgery patients prior to the pilot project for 6 months.
Results: 34 patients in the pre-intervention group and 28 patients in the Project RED-S group were examined. Due to the small sample size, there were no differences between the two groups across demographics, intra-operative, and post-operative outcomes, including surgical site infection, length of stay, or discharge to facility other than home. The Project RED-S patients had favorable rates of 30-day readmission (18% vs. 23%) and mortality (0% vs. 9%) although statistical significance was not reached. In addition, the cognitive interviews with patients, their care givers and clinicians demonstrated improved patients’ experience with discharge process.
Conclusions: Even though some readmissions are inevitable, the current evidence suggests that the rate of readmission could be reduced with carefully planned perioperative strategies. The pilot Project RED-S generated positive feedback and proof of concept in surgical patients. Currently, we are in the process of implementing a hospital wide readmission tool coordinating multidisciplinary effort from the day of admission to outpatient care after discharge in a larger patient population.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80499
Program Number: P638
Presentation Session: Poster (Non CME)
Presentation Type: Poster