title: Decision support tool use in colorectal surgery: what is the role?
abstract: BACKGROUND
  Decision support tools prioritizing transitional care can help decrease medical readmissions but little evidence exists within surgical specialties.
  
  
  METHODS
  This study evaluated the use of early screen for discharge planning and discharge decision support system screening tools or selective multidisciplinary clinical evaluation for targeting post-acute care interventions among higher risk colorectal surgery patients based on 30-d readmission status. Patients with positive screening tool scores underwent standard discharge planning education and evaluation during index operation hospitalization and were referred for targeted post-acute interventions; patients with negative screening tool scores were further clinically evaluated for selective referral for post-acute interventions.
  
  
  RESULTS
  We identified 300 colorectal surgery patients; 30.3% (n = 91) of patients had a positive screening score (early screen for discharge planning and/or discharge decision support system). Positive screening scores did not correlate with hospital readmission (35% of readmitted patients versus 29% of non-readmitted had a positive screen; P = 0.424). After negative screening scores, selective referral based on clinical assessment for postdischarge interventions helped to concentrate resources in patients who were later readmitted. Index hospitalization complications were significantly associated with positive screening tool scores whereas postdischarge complications were most predictive of readmission.
  
  
  CONCLUSIONS
  Among colorectal surgery patients, selective clinical referrals appeared to be the best method for targeting post-acute interventions in patients at higher risk for readmission. Future research should focus on improving existing processes of care to reduce postoperative complications and constructing better tools to assess individual patients' needs for targeted interventions in the post-acute setting.
authors.affiliation: Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland. Electronic address: ewick1@jhmi.edu.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Hechenbleikner
authors.affiliation: Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Martin
authors.initials: M
authors.lastname: Makary
authors.affiliation: Statistical Engineering Division, Information Technology Laboratory, National Institute of Standards and Technology, Gaithersburg, Maryland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Samarov
authors.affiliation: Department of Utilization and Clinical Resource Management, Johns Hopkins Health System, Baltimore, Maryland.
authors.forename: Curtis
authors.initials: C
authors.lastname: Leung
authors.affiliation: Department of Utilization and Clinical Resource Management, Johns Hopkins Health System, Baltimore, Maryland.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Miller
authors.affiliation: Department of Utilization and Clinical Resource Management, Johns Hopkins Health System, Baltimore, Maryland.
authors.forename: Amy
authors.initials: A
authors.lastname: Deutschendorf
authors.affiliation: Division of General Internal Medicine, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Brotman
authors.affiliation: Division of Nursing Research, Mayo Clinic, Rochester, Minnesota.
authors.forename: Diane E
authors.initials: DE
authors.lastname: Holland
authors.affiliation: University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.
authors.forename: Kathryn H
authors.initials: KH
authors.lastname: Bowles
authors.affiliation: Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Wick
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000601:surgery*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control
keywords: Colorectal surgery; Decision support tools; Readmissions