A Patient-Centered Early Warning System to Prevent Readmission after Colorectal Surgery: A National Consensus Using the Delphi Method - 13/01/13
Abstract |
Background |
Warnings of deteriorating condition provided to patients at hospital discharge are highly subjective, based on conventional wisdom, and lack systematic implementation. We conducted a standardized Delphi process to achieve national consensus on warning indicators and recommended action plans for patients after colorectal surgery.
Study Design |
Expert panel eligibility was determined by pre-established criteria. A preliminary meeting was held at a national surgical conference followed by 5 rounds of email questionnaires and 1 teleconference using the Delphi method. Consensus was defined when at least 70% of the experts rated a symptom as 4 or more on a 5-point Likert scale (agree or strongly agree).
Results |
Eleven experts were recruited to participate in the national consensus panel. A consensus was reached at Round 5. Experts identified 10 symptoms that indicate patients should notify their physician: “wound drainage,” “wound opening,” “wound redness or changes in the skin around the wound,” “no bowel movement or lack of gas/stool from an ostomy for more than 24 hours,” “increasing abdominal pain,” “vomiting,” “abdominal swelling,” “high ostomy output and/or dark urine or no urine,” “fever greater than 101.5°F,” and “not being able to take anything by mouth for more than 24 hours.” Two additional symptoms should alert the patient to seek emergency care: “shortness of breath or inability to breathe” and “chest pain.”
Conclusions |
Expert consensus on discharge warning signs and appropriate action plans are identified for patients after colorectal surgery. The result of this study will help develop a more sophisticated patient-centered discharge tool for surgical patients.
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Disclosure Information: Nothing to disclose. |
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This study was conducted with resources and use of facilities at the Houston VA Health Services Research and Development Center of Excellence (HFP90-020) at the Michael E DeBakey VA Medical Center. Dr Naik received support from a Doris Duke Charitable Foundation Clinical Scientist Development Award during the time period of this study. Dr Berger holds a grant from the Cancer Prevention and Research Institute of Texas and a VERC grant from the Veterans’ Intergrated Service Network 16. None of these funding agencies had any involvement in data collection, analysis, review of results, or approval of the final manuscript. |
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Drs Berger and Naik contributed equally to this work. |
Vol 216 - N° 2
P. 210 - février 2013 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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