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Reducing Bariatric Readmissions

Credits: None available.

Background: Evidence has shown that readmission rates cost over $27 billion annually. One in ten post-op bariatric patients will have at least one ER visit, primarily for nausea/vomiting, dehydration, and abdominal pain, which are preventable with proper interventions. In 2019, nursing staff from an inpatient unit (7T) and the bariatric clinic at Brooke Army Medical Center (BAMC) identified a 15% increase in bariatric readmissions. This exceeds the national average of 11.3% (Sharma & Nam, 2019). The current discharge process for surgical patients includes utilization of enhanced recovery after surgery (ERAS) protocol. A retrospective data review collected from January-June 2019 found 115 bariatric surgeries with 17 30-day readmissions related to PO intolerance. Efforts to reduce rates below the 10% benchmark include incorporating concepts of enhanced recovery after bariatric surgery (ERABS) protocol into the current discharge process and 100% staff education.

Objective: The objective is to implement ERABS concepts into the current discharge process in an effort to reduce 30-day readmissions for bariatric surgery patients.

Methods: Our EBP project is guided by the IOWA model as an opportunity to improve a system identified trigger: 13% readmission rate within 30 days of discharge. Currently, nurses from the bariatric clinic do not participate in teaching with patients on the day of discharge nor do they meet with every patient prior to discharge. This presents the opportunity for 7T nurses to make an impact on bariatric specific discharge teaching and education. Staff will be given a survey to assess their knowledge on bariatric discharge teaching. Based on the results, the team will collaborate with the bariatric clinic to create an in-service specific to discharge teaching. Staff knowledge will then be reassessed. Concepts from ERABS will be added to the current process.
• Strict protocol-based medical and nursing care: Nursing care plans will be designed for bariatric surgery.
• Defined discharge information sheets: “bariatric surgery discharge guide,” “teach-back methods,” and “ask me 3” teaching tools will be provided to patients and family. Compliance of teaching will be reviewed under the “patient discharge note.”
• A retrospective data review for 30-day readmissions for patients undergoing bariatric surgeries between January 1, 2021, to January 5, 2021, will be compared to data from January-June 2019.

Results: The implementation phase began February 2020 and was delayed due to COVID-19. Post-implementation data has been collected for 13 months. The sample population is n=267 (n=115 [2019] n=151 [Jan 2021-Jan 2022]). Interventions decreased readmissions for bariatric surgeries from 17 readmissions (15%) to 12 readmissions (7.9%), a savings of approximately $27,000 to $65,000 per patient per readmission.

Conclusion: Official conclusions will be completed at a time to be determined and the following outcomes are expected to occur: 1) staff will be given a survey to assess their knowledge awareness of newly implemented guidance; 2) staff will be assessed on the use of bariatric care plans; 3) staff will be assessed on the use of bariatric surgery discharge guide, teach-back method, and ask me 3 tool; and 4) a decrease in 30-day readmissions for bariatric surgery readmissions.

Evidence-based references
1. Schroeder, Robin, et al. "Treatment of Adult Obesity with Bariatric Surgery." American Academy of Family Physicians, vol. 93, no. 1, 1 Jan. 2016, pp. 31-37.
2. Telem, Dana, et al. "Outcomes of Bariatric Surgery." UpToDate. UpToDate, www.uptodate.com. Accessed 8 Sept. 2019. Originally published in UpToDate, May 2019, pp. 1-42.
3. Lim, Robert B. "Bariatric Procedures for the Management of Severe Obesity: descriptions." UpToDate. UpToDate, www.uptodate.com. Accessed 15 May 2019. Originally published in Wolters Kluwer, May 2019, pp. 1-44.
4. Bradley, Joel F., III, et al. "Complications of Bariatric Surgery: The Acute Care Surgeon's Experience." The American Journal of Surgery, no. 210, 2015,pp. 456-61, dx.doi.org/10.1016/j.amjsurg.2015.03.004. Accessed 15 May 2019.
5. "Bariatric Surgery." National Institute of Diabetes and Digestive and Kidney Diseases, July 2016, pp. 1-17, www.niddk.nih.gov/. Accessed 15 May 2019.
6. Chand, Bipan, and Pornthep Prathanvanich. "Critical Care Management of Bariatric Surgery Complications." Journal of Intensive Care Medicine, vol. 31, no. 8, 2016, pp. 511-28, doi:10.1177/0885066615593067. Accessed 15 May 2019.
7. Lim, Robert B., and Daniel Jones. "Bariatric Operative Procedures: Thirty-Day Morbidity and Mortality." UpToDate, www.UpToDate.com. Accessed 10 June 2019. Originally published in Wolters Kluwer, 10 June 2018, pp. 1-26.



Credits: None available.

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