Brandon T. Gaston MD, Zachary M. Feldman MD, MPH, Tiffany R. Bellomo MD, Sujin Lee MD, Srihari K. Lella MD, Bianca Mulaney MD, Patricia Finneran CNP, Jennifer Bocklett CNP, Laura Lima CNP, Patricia Baptiste CNP, Maura Hines CNP, Sunita Srivastava MD, Anahita Dua MD, MBA, Matthew J. Eagleton MD, Nikolaos Zacharias MD, MPH
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引用次数: 0
Abstract
Objective
Thirty-day readmission rates after surgery are being increasingly used as a quality performance metric. Readmission rates in vascular surgery are frequently reported to be higher than other surgical specialties, and many coordinated efforts have been developed at local and national levels to reduce avoidable readmissions.
Methods
We constructed a multi-pronged readmission reduction quality improvement (QI) initiative aimed at addressing the clinical drivers of readmission after vascular surgery. Proposed interventions were implemented in Plan-Do-Study-Act (PDSA) cycles. Interventions aimed to improve patient communication and included post-discharge phone calls; mandatory follow-up before 2 weeks, with in-person visits required for all groin incisions and ischemic lower extremity wounds; and protocolized distribution of “calling cards,” which contained emergency and routine contact information. The primary outcome measure was 30-day readmission rate.
Results
After implementation of a multi-modal QI initiative, there was a statistically significant decrease in the 30-day readmission rate, from 14.1% to 8.2% (P = .02). A slightly higher percentage of readmissions, 57%, occurred within the first 2 weeks of discharge.
Conclusions
The consensus-driven development and implementation of a QI protocol to reduce 30-day readmission, based on increased patient communication and more standardized patient follow-up, showed promising results at our institution. Further efforts to improve readmission should focus on decreasing barriers to patient-provider communication after discharge.