Patient autonomy-centered self-care checklist reduces hospital readmissions after ileostomy creation.
Patients who undergo a colorectal operation that includes a new ileostomy incur high rates of readmission. Ostomates face a steep learning curve to master the skills and knowledge needed for success at home. We designed and implemented a patient-centered checklist promoting independence and validating self-care knowledge and care skills and evaluated its effect on readmissions after ileostomy creation.



On a single inpatient unit, new ileostomy patients were taught and evaluated using a novel postoperative self-care checklist, while perioperative care for ostomates remained unchanged elsewhere in the institution. In a retrospective cohort including all consecutive ileostomy patients from 2 years before (period 1) and 1 year after (period 2) the checklist implementation, we identified univariable predictors of readmission within 30 days of discharge and used a multivariable, difference-in-differences approach to compare trends in readmission between the intervention and control units.



Of the 430 patients in the study period, there were 116 with readmissions (26%). Readmitted patients had significantly greater all patient refined diagnosis related group weights (3.6 vs 3.3, P = .006) and longer initial duration of stay (13.3 vs 11.3 days, P = .006), and they were more likely to be emergency admissions (49% vs 38%, P = .04). The readmission rate on the intervention unit decreased from 28% in period 1 to 20% in period 2. The logistic regression-based difference-in-differences approach revealed that implementation of the checklist was an independent negative predictor of readmission (P = .04).



Implementation of a patient-centered, self-care-oriented postoperative education checklist was associated with significantly reduced odds of readmission after ileostomy creation.
Division of Colorectal Surgery, University of Michigan, Ann Arbor, MI. Electronic address: kmha@med.umich.edu.
Karin M
KM
Hardiman
Department of Nursing, University of Michigan, Ann Arbor, MI.
Christina D
CD
Reames
Department of Biostatistics, University of Michigan, Ann Arbor, MI.
Marshall C
MC
McLeod
Division of Colorectal Surgery, University of Michigan, Ann Arbor, MI.
Scott E
SE
Regenbogen
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015331:Cohort Studies; D003082:Colectomy / Q000379:methods; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery; D003266:Continuity of Patient Care; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects* / Q000379:methods; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010359:Patient Readmission / Q000706:statistics & numerical data*; D018802:Patient-Centered Care / Q000379:methods; D026684:Personal Autonomy; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012648:Self Care / Q000379:methods*