title: Cost Effectiveness of a Novel Attempt to Reduce Readmission after Ileostomy Creation.
abstract: OBJECTIVE
  Dehydration is a common complication after ileostomy creation and is the most frequent reason for postoperative readmission to the hospital. We sought to determine the clinical and economic impact of an outpatient intervention to decrease readmissions for dehydration after ileostomy creation.
  
  
  METHODS
  All new ileostomates from 09/2011 through 10/2012 at the University of Florida were enrolled to receive an ileostomy education and management protocol and a daily telephone call for 3 weeks after discharge. Counseling and medication adjustments were provided, with a satisfaction survey at the end. Outcomes of these patients were compared to those in a historical control cohort. A cost analysis was conducted to calculate the savings to the hospital.
  
  
  RESULTS
  Thirty-eight patients were enrolled. All patients required telephone counseling, and the mean satisfaction score rating was 4.69, on a scale of 1 to 5. The readmission rate for dehydration within 30 days of discharge decreased significantly from 65% before intervention to 16% (5/32 patients) after intervention (P= .002). The length of readmission hospital stay decreased from a mean of 4.2 days before the introduction of the intervention to 3 days after. Cost analysis revealed that the actual total hospital cost of dehydration-specific readmission decreased from $88,858 to $25,037, a saving of $63,821.
  
  
  CONCLUSIONS
  A standardized ileostomy pathway with comprehensive patient education and outpatient telephone follow-up is cost effective, has a positive influence on patient satisfaction, and reduces dehydration-related readmission rates.
authors.forename: Atif
authors.initials: A
authors.lastname: Iqbal
authors.affiliation: Ahsan Raza, MD, Department of Surgery, University of Florida, P. O. Box 100109, Gainesville, Florida, USA.
authors.forename: Ahsan
authors.initials: A
authors.lastname: Raza
authors.affiliation: Department of Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Emina
authors.initials: E
authors.lastname: Huang
authors.affiliation: Ahsan Raza, MD, Department of Surgery, University of Florida, P. O. Box 100109, Gainesville, Florida, USA.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Goldstein
authors.affiliation: Ahsan Raza, MD, Department of Surgery, University of Florida, P. O. Box 100109, Gainesville, Florida, USA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Hughes
authors.affiliation: Ahsan Raza, MD, Department of Surgery, University of Florida, P. O. Box 100109, Gainesville, Florida, USA.
authors.forename: Sanda A
authors.initials: SA
authors.lastname: Tan
mesh_terms: D003266:Continuity of Patient Care; D003362:Cost-Benefit Analysis; D003376:Counseling; D003681:Dehydration / Q000453:epidemiology; D005260:Female; D005431:Florida / Q000453:epidemiology; D017721:Hospital Costs; D006801:Humans; D007081:Ileostomy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D017216:Telemedicine; D013689:Telephone
keywords: Dehydration; Ileostomy; Readmission