title: Decreasing Hospital Readmission in Ileostomy Patients: Results of Novel Pilot Program.
abstract: BACKGROUND
  Nearly 30% of patients with newly formed ileostomies require hospital readmission from severe dehydration or associated complications. This contributes to significant morbidity and rising healthcare costs associated with this procedure. Our aim was to design and pilot a novel program to decrease readmissions in this patient population.
  
  
  METHODS
  An agreement was established with Visiting Nurse Health System (VNHS) in March 2015 that incorporated regular home visits with clinical triggers to institute surgeon-supervised corrective measures aimed at preventing patient decompensation associated with hospital readmissions. Thirty-day readmission data for patients managed with and without VNHS support for 10.5 months before and after implementation of this new program were collected.
  
  
  RESULTS
  Of 833 patients with small bowel procedures, 162 were ileostomies with 47 in the VNHS and 115 in the non-VNHS group. Before program implementation, VNHS (n = 24) and non-VNHS patients (n = 54) had similar readmission rates (20.8% vs 16.7%). After implementation, VNHS patients (n = 23) had a 58% reduction in hospital readmission (8.7%) and non-VNHS patient hospital readmissions (n = 61) increased slightly (24.5%). Total cost of readmissions per patient in the cohort decreased by >80% in the pilot VNHS group.
  
  
  CONCLUSIONS
  Implementation of a novel program reduced the 30-day readmission rate by 58% and cost of readmissions per patient by >80% in a high risk for readmission patient population with newly created ileostomies. Future efforts will expand this program to a greater number of patients, both institutionally and systemically, to reduce the readmission-rate and healthcare costs for this high-risk patient population.
authors.affiliation: Department of Surgery, Emory University, Atlanta, GA. Electronic address: virginia.o.shaffer@emory.edu.
authors.forename: Virginia O
authors.initials: VO
authors.lastname: Shaffer
authors.affiliation: Emory Healthcare Brain Health Center, Atlanta, GA.
authors.forename: Tari
authors.initials: T
authors.lastname: Owi
authors.affiliation: Emory Healthcare, Atlanta, GA.
authors.forename: Mathu A
authors.initials: MA
authors.lastname: Kumarusamy
authors.affiliation: Department of Surgery, Emory University, Atlanta, GA.
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Sullivan
authors.affiliation: Department of Surgery, Emory University, Atlanta, GA.
authors.forename: Jahnavi K
authors.initials: JK
authors.lastname: Srinivasan
authors.affiliation: Department of Surgery, Emory University, Atlanta, GA; Winship Cancer Institute, Atlanta, GA.
authors.forename: Shishir K
authors.initials: SK
authors.lastname: Maithel
authors.affiliation: Department of Surgery, Emory University, Atlanta, GA; Winship Cancer Institute, Atlanta, GA.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Staley
authors.affiliation: Department of Surgery, Emory University, Atlanta, GA.
authors.forename: John F
authors.initials: JF
authors.lastname: Sweeney
authors.affiliation: Department of Neurology, Office of Quality and Project Management, Emory University, Atlanta, GA.
authors.forename: Greg
authors.initials: G
authors.lastname: Esper
mesh_terms: D000359:Aftercare / Q000191:economics / Q000379:methods* / Q000458:organization & administration; D005500:Follow-Up Studies; D064650:Home Health Nursing / Q000191:economics / Q000379:methods* / Q000458:organization & administration; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007081:Ileostomy / Q000191:economics; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D010865:Pilot Projects; D011182:Postoperative Care / Q000191:economics / Q000379:methods* / Q000592:standards; D058996:Quality Improvement / Q000191:economics / Q000458:organization & administration; D019984:Quality Indicators, Health Care / Q000191:economics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States