Background: Patients who undergo a colorectal operation that includes a new ileostomy incur high rates of readmission. Ostomates face a steep learning curve to master the skills and knowledge needed for success at home. We designed and implemented a patient-centered checklist promoting independence and validating self-care knowledge and care skills and evaluated its effect on readmissions after ileostomy creation.
Methods: On a single inpatient unit, new ileostomy patients were taught and evaluated using a novel postoperative self-care checklist, while perioperative care for ostomates remained unchanged elsewhere in the institution. In a retrospective cohort including all consecutive ileostomy patients from 2 years before (period 1) and 1 year after (period 2) the checklist implementation, we identified univariable predictors of readmission within 30 days of discharge and used a multivariable, difference-in-differences approach to compare trends in readmission between the intervention and control units.
Results: Of the 430 patients in the study period, there were 116 with readmissions (26%). Readmitted patients had significantly greater all patient refined diagnosis related group weights (3.6 vs 3.3, P = .006) and longer initial duration of stay (13.3 vs 11.3 days, P = .006), and they were more likely to be emergency admissions (49% vs 38%, P = .04). The readmission rate on the intervention unit decreased from 28% in period 1 to 20% in period 2. The logistic regression-based difference-in-differences approach revealed that implementation of the checklist was an independent negative predictor of readmission (P = .04).
Conclusion: Implementation of a patient-centered, self-care-oriented postoperative education checklist was associated with significantly reduced odds of readmission after ileostomy creation.
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