title: A patient-centered early warning system to prevent readmission after colorectal surgery: a national consensus using the Delphi method.
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.
  
  
  METHODS
  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.
authors.affiliation: Department of Surgery, Baylor College of Medicine, Houston, TX, USA. Linday@bcm.edu
authors.forename: Linda T
authors.initials: LT
authors.lastname: Li
authors.forename: Whitney L
authors.initials: WL
authors.lastname: Mills
authors.forename: Amanda M
authors.initials: AM
authors.lastname: Gutierrez
authors.forename: Levi I
authors.initials: LI
authors.lastname: Herman
authors.forename: David H
authors.initials: DH
authors.lastname: Berger
authors.forename: Aanand D
authors.initials: AD
authors.lastname: Naik
mesh_terms: D003107:Colorectal Surgery; D003697:Delphi Technique; D006801:Humans; D010351:Patient Discharge / Q000592:standards*; D010359:Patient Readmission; D011237:Predictive Value of Tests; D012955:Societies, Medical; D011795:Surveys and Questionnaires