Halverson Amy L, Sellers Morgan M, Bilimoria Karl Y, Hawn Mary T, Williams Mark V, McLeod Robin S, Ko Clifford Y
Department of Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair, Suite 650, Chicago, IL, 60611, USA,
J Gastrointest Surg. 2014 Aug;18(8):1407-15. doi: 10.1007/s11605-013-2429-5. Epub 2014 Jun 10.
Readmission rates after intestinal surgery have been notably high, ranging from 10 % for elective surgery to 21 % for urgent/emergent surgery. Other than adherence to established strategies for decreasing individual postoperative complications, there is little guidance available for providers to work toward reducing their postoperative readmission rates.
Processes of care that may affect postoperative readmissions were identified through a systematic literature review, assessment of existing guidelines, and semi-structured interviews with individuals who have expertise in hospital readmissions and surgical quality improvement. Eleven experts ranked potential process measures for validity on the basis of the RAND/University of California, Los Angeles Appropriateness Methodology.
Of 49 proposed process measures, 34 (69 %) were rated as valid. Of the 34 valid measures, two measures addressed care in the preoperative period. These included evaluation of patient's comorbidities, providing written instruction detailing the anticipated perioperative course, and communication with the patient's referring or primary care doctor. A measure addressing perioperative care stated that institutions should have a standardized perioperative care protocol. Additional measures focused on discharge instructions and communication.
An expert panel identified several aspects of care that are considered essential to quality patient care and important to reducing postoperative readmissions.
肠道手术后的再入院率一直显著偏高，择期手术的再入院率为10%，急诊/紧急手术则为21%。除了遵循既定策略以减少个体术后并发症外，医疗服务提供者在努力降低术后再入院率方面几乎没有可遵循的指导。
通过系统的文献综述、对现有指南的评估以及对医院再入院和手术质量改进方面的专家进行半结构化访谈，确定了可能影响术后再入院的护理流程。11位专家根据兰德/加利福尼亚大学洛杉矶分校适用性方法对潜在的流程措施进行了有效性排名。
在49项提议的流程措施中，34项（69%）被评为有效。在这34项有效措施中，两项措施涉及术前护理。这些措施包括评估患者的合并症、提供详细说明预期围手术期过程的书面指导以及与患者的转诊医生或初级保健医生沟通。一项涉及围手术期护理的措施指出，机构应有标准化的围手术期护理方案。其他措施则侧重于出院指导和沟通。
一个专家小组确定了护理的几个方面，这些方面被认为对优质患者护理至关重要，对降低术后再入院率也很重要。
