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A Patient-Centered Early Warning System to Prevent Readmission after Colorectal Surgery: A National Consensus Using the Delphi Method - 13/01/13

Doi : 10.1016/j.jamcollsurg.2012.10.011 
Linda T. Li, MD a, , Whitney L. Mills, PhD c, Amanda M. Gutierrez d, Levi I. Herman, BS c, David H. Berger, MD, MHCM, FACS a, d, e, Aanand D. Naik, MD b, d, f
a Department of Surgery, Baylor College of Medicine, Houston, TX 
b Department of Internal Medicine, Baylor College of Medicine, Houston, TX 
c Houston Veterans Affairs Health Services Research and Development Center of Excellence, Houston, TX 
d Rice University, Houston, TX 
e Operative Care Line, Michael E DeBakey Veterans Affairs Medical Center, Houston, TX 
f Medical Care Line, Michael E DeBakey Veterans Affairs Medical Center, Houston, TX 

Correspondence address: Linda T Li, MD, Houston VA HSR&D Center of Excellence (152), 2002 Holcombe Blvd, Houston, TX 77030.

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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Plan


 Disclosure Information: Nothing to disclose.
 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.
 Drs Berger and Naik contributed equally to this work.


© 2013  American College of Surgeons. Tous droits réservés.
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Vol 216 - N° 2

P. 210 - février 2013 Retour au numéro
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