System-Wide Improvement for Transitions After Surgery: The SWIFT Post op Program
| Status: | Completed |
|---|---|
| Conditions: | Colorectal Cancer |
| Therapuetic Areas: | Oncology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 12/31/2017 |
| Start Date: | October 2014 |
| End Date: | November 11, 2016 |
Short-term post-operative complications after colon and rectal surgery present a known major
clinical and financial burden for patients and hospitals. Focused efforts to reduce
readmissions after colorectal surgery is one potentially high-yield and broad approach to
address this problem since post- operative complications are the strongest predictor of
readmissions. We focus on decreasing readmissions after ileostomy surgery by using a
previously published intervention that prevents dehydration in the outpatient setting and
decreases acute renal failure complications. We plan to introduce the SWIFT post op program
for ileostomy patients at one academic and two community hospitals which are part of a single
health care system, and to then randomize patients to usual care in the setting of this new
program versus an aggressive compliance surveillance and improvement strategy (CSIS) strategy
using study personnel. Our primary study outcome is all-cause 30-day readmission, and our
secondary outcomes include patient satisfaction (CAHPS scores) and a cost-benefit analysis.
We seek to create a partnership between colorectal surgeons, inpatient nurse managers and
wound ostomy continence nurses (WOCN) at the three sites, linking them with outpatient nurse
practitioners and physician's assistants at the respective colorectal surgery clinics who
facilitate care-transition after hospital discharge.
clinical and financial burden for patients and hospitals. Focused efforts to reduce
readmissions after colorectal surgery is one potentially high-yield and broad approach to
address this problem since post- operative complications are the strongest predictor of
readmissions. We focus on decreasing readmissions after ileostomy surgery by using a
previously published intervention that prevents dehydration in the outpatient setting and
decreases acute renal failure complications. We plan to introduce the SWIFT post op program
for ileostomy patients at one academic and two community hospitals which are part of a single
health care system, and to then randomize patients to usual care in the setting of this new
program versus an aggressive compliance surveillance and improvement strategy (CSIS) strategy
using study personnel. Our primary study outcome is all-cause 30-day readmission, and our
secondary outcomes include patient satisfaction (CAHPS scores) and a cost-benefit analysis.
We seek to create a partnership between colorectal surgeons, inpatient nurse managers and
wound ostomy continence nurses (WOCN) at the three sites, linking them with outpatient nurse
practitioners and physician's assistants at the respective colorectal surgery clinics who
facilitate care-transition after hospital discharge.
At the start of the study, inpatient and outpatient nurses, physicians and physicians
assistants will be oriented to the intervention in the study and will be suggested that the
intervention is standard of care based on the following study:
Nagle D, Pare T, Keenen E, Marcet K, Tizio S, Poylin V*. Ileostomy Pathway Virtually
Eliminates Readmissions for Dehydration in New Ostomates. Diseases of the Colon and Rectum
2012; 55: 1266-1272.
The intervention patients will be subject to a compliance surveillance and intervention
strategy (CSIS) administered by study personnel to encourage the following and persist with
telephone calls if the following have not been achieved.
- Prospective audits by study personnel to check and encourage teaching in the clinic,
teaching on the wards, and telephone follow up occurred.
- A self-assessment tool for patients and families to confirm understanding of the
education materials.
- Coaching of inpatient nurses taking care of ileostomy patients by WOCN and/or the
inpatient nurse champion
- Call from the clinic nurse practitioner or physician's assistant within 7 days of
discharge to review the educational materials and administer a screening questionnaire
to identify patients at risk of dehydration. In patients randomized to CSIS, study
personnel will ensure this phone call is made.
The usual care arm will include no such surveillance.
The randomized study will be powered to detect a decrease in hospital readmission rates
(all-cause) from 25% to 5%. Secondary outcomes include readmission due to dehydration and
patient satisfaction (Surgical-CAHPS survey)
assistants will be oriented to the intervention in the study and will be suggested that the
intervention is standard of care based on the following study:
Nagle D, Pare T, Keenen E, Marcet K, Tizio S, Poylin V*. Ileostomy Pathway Virtually
Eliminates Readmissions for Dehydration in New Ostomates. Diseases of the Colon and Rectum
2012; 55: 1266-1272.
The intervention patients will be subject to a compliance surveillance and intervention
strategy (CSIS) administered by study personnel to encourage the following and persist with
telephone calls if the following have not been achieved.
- Prospective audits by study personnel to check and encourage teaching in the clinic,
teaching on the wards, and telephone follow up occurred.
- A self-assessment tool for patients and families to confirm understanding of the
education materials.
- Coaching of inpatient nurses taking care of ileostomy patients by WOCN and/or the
inpatient nurse champion
- Call from the clinic nurse practitioner or physician's assistant within 7 days of
discharge to review the educational materials and administer a screening questionnaire
to identify patients at risk of dehydration. In patients randomized to CSIS, study
personnel will ensure this phone call is made.
The usual care arm will include no such surveillance.
The randomized study will be powered to detect a decrease in hospital readmission rates
(all-cause) from 25% to 5%. Secondary outcomes include readmission due to dehydration and
patient satisfaction (Surgical-CAHPS survey)
Inclusion Criteria:
- Patients who are scheduled or who undergo ileostomy alone or as part of a multiple
procedure operation
- patients who have had an ileostomy in the past are eligible
- patients who have an ileostomy to address a recent surgical complication are eligible
Exclusion Criteria:
- Patients who have an ileostomy already in place immediately prior to the procedure
(ie. revision, transposition, or parastomal hernia procedures
- patients on dialysis
- patients who require chronic TPN, IVF, or have short gut
- non-English speaking patients who do not have easy access to an appropriate
interpreter.
We found this trial at
2
sites
2450 Riverside Ave
Minneapolis, Minnesota 55454
Minneapolis, Minnesota 55454
(612) 273-3000
Phone: 612-625-7992
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