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Improving Patient-Centered Transitional Care after Complex Abdominal Surgery.

Publication ,  Journal Article
Acher, AW; Campbell-Flohr, SA; Brenny-Fitzpatrick, M; Leahy-Gross, KM; Fernandes-Taylor, S; Fisher, AV; Agarwal, S; Kind, AJ; Greenberg, CC ...
Published in: J Am Coll Surg
August 2017

BACKGROUND: Poor-quality transitions of care from hospital to home contribute to high rates of readmission after complex abdominal surgery. The Coordinated Transitional Care (C-TraC) program improved readmission rates in medical patients, but evidence-based surgical transitional care protocols are lacking. This pilot study evaluated the feasibility and preliminary effectiveness of an adapted surgical C-TraC protocol. STUDY DESIGN: The intervention includes in-person enrollment of patients. Follow-up protocolized phone calls by specially trained surgical C-TraC nurses addressed medication management, clinic appointments, operation-specific concerns, and identification of red-flag symptoms. Enrollment criteria included pancreatectomy, gastrectomy, operative small bowel obstruction or perforation, ostomy, discharge with a drain, in-hospital complication, and clinician discretion. Engaged patients participated in the first phone call, which was within 48 to 72 hours of discharge and continued every 3 to 4 days. Patients completed the program once they and surgical C-TraC nurse agreed that no additional follow-up was needed or the patient was readmitted. RESULTS: Two hundred and twelve patients were enrolled, October 2015 through April 2016, with a mean age of 56 years (range 19 to 89 years); 33% of patients were 65 years or older. Surgery sites included colon (46%), small bowel (16%), pancreas (12%), multivisceral (9%), liver (4.5%), retroperitoneum/soft tissue (4.5%), gastric (4%), biliary (2%), and appendix (1.5%). Refusal rate was 1% and engagement was 95%. At initial call, 47% of patients had at least 1 medication discrepancy (range 0 to 6). Mean number of calls from provider to patient was 3.2 (range 0 to 20, median 3). CONCLUSIONS: A phone-based transitional care protocol for surgical patients is feasible, with <1% refusals and 95% engagement. Medication management is a prominent issue. Future studies are needed to assess the impact of surgical C-TraC on post-discharge healthcare use.

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Published In

J Am Coll Surg

DOI

EISSN

1879-1190

Publication Date

August 2017

Volume

225

Issue

2

Start / End Page

259 / 265

Location

United States

Related Subject Headings

  • Young Adult
  • Transitional Care
  • Surgery
  • Quality Improvement
  • Pilot Projects
  • Patient-Centered Care
  • Middle Aged
  • Male
  • Humans
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
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Acher, A. W., Campbell-Flohr, S. A., Brenny-Fitzpatrick, M., Leahy-Gross, K. M., Fernandes-Taylor, S., Fisher, A. V., … Weber, S. M. (2017). Improving Patient-Centered Transitional Care after Complex Abdominal Surgery. J Am Coll Surg, 225(2), 259–265. https://doi.org/10.1016/j.jamcollsurg.2017.04.008
Acher, Alexandra W., Stephanie A. Campbell-Flohr, Maria Brenny-Fitzpatrick, Kristine M. Leahy-Gross, Sara Fernandes-Taylor, Alexander V. Fisher, Suresh Agarwal, et al. “Improving Patient-Centered Transitional Care after Complex Abdominal Surgery.J Am Coll Surg 225, no. 2 (August 2017): 259–65. https://doi.org/10.1016/j.jamcollsurg.2017.04.008.
Acher AW, Campbell-Flohr SA, Brenny-Fitzpatrick M, Leahy-Gross KM, Fernandes-Taylor S, Fisher AV, et al. Improving Patient-Centered Transitional Care after Complex Abdominal Surgery. J Am Coll Surg. 2017 Aug;225(2):259–65.
Acher, Alexandra W., et al. “Improving Patient-Centered Transitional Care after Complex Abdominal Surgery.J Am Coll Surg, vol. 225, no. 2, Aug. 2017, pp. 259–65. Pubmed, doi:10.1016/j.jamcollsurg.2017.04.008.
Acher AW, Campbell-Flohr SA, Brenny-Fitzpatrick M, Leahy-Gross KM, Fernandes-Taylor S, Fisher AV, Agarwal S, Kind AJ, Greenberg CC, Carayon P, Weber SM. Improving Patient-Centered Transitional Care after Complex Abdominal Surgery. J Am Coll Surg. 2017 Aug;225(2):259–265.
Journal cover image

Published In

J Am Coll Surg

DOI

EISSN

1879-1190

Publication Date

August 2017

Volume

225

Issue

2

Start / End Page

259 / 265

Location

United States

Related Subject Headings

  • Young Adult
  • Transitional Care
  • Surgery
  • Quality Improvement
  • Pilot Projects
  • Patient-Centered Care
  • Middle Aged
  • Male
  • Humans
  • Female