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Two-Center Validation of a Novel Quality Improvement Protocol to Avoid Postileostomy Morbidity Using Home Intravenous Fluids and Structured Daily Calls
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DOI：10.1097/DCR.0000000000003629.png)
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Abstract
En 中文
BACKGROUND: New ileostomates have higher rates of dehydration and readmission compared to patients undergoing other colorectal procedures. OBJECTIVE: We aimed to show the efficacy of a novel ileostomy-specific quality improvement protocol at an academic center with subsequent validation at another academic center. DESIGN: Prospective cohort study. SETTING: Baylor College of Medicine (Houston, TX) and University of Florida Health (Gainesville, Florida). PATIENTS: Patients who underwent elective ileostomy creation were enrolled in 2 phases: phase I (efficacy phase) from 2011 to 2018 at the University of Florida and phase II (validation phase) from 2018 to 2024 at Baylor College of Medicine. INTERVENTIONS: New ileostomates received an indwelling intravenous line postoperatively. After discharge, daily home visits and administration of intravenous fluid infusions were completed by a registered nurse, and daily phone calls were made for counseling and medication adjustment by an advanced practice provider. MAIN OUTCOME MEASURES: Length of stay, readmission rate, complication rate, and cost of care. RESULTS: A total of 600 patients were enrolled in the study. There was a significant improvement in postprotocol from preprotocol in hospital length of stay (University of Florida: 3 vs 8 days; Baylor College of Medicine: 2.1 vs 6.9 days, p < 0.01), readmission rates (University of Florida: 9% vs 56%; Baylor College of Medicine: 7% vs 40%, p < 0.01), cost of care (University of Florida: $19,700 vs $53,300; Baylor College of Medicine: $18,100 vs $47,856, p < 0.01), and complication rates (University of Florida: 19% vs 65%; Baylor College of Medicine: 17% vs 46%, p < 0.01). If readmitted, the length of stay and cost decreased by 81% and 83%, respectively. No line-related complication was noted. LIMITATIONS: This study was not randomized. Resource and insurance limitations may be an impediment to protocol implementation for austere settings. CONCLUSIONS: Implementation of a novel ileostomy-specific standardized protocol to avoid morbidity from dehydration by implementing home intravenous infusions in conjunction with comprehensive outpatient education and phone follow-up significantly improved the quality of care by decreasing the length of stay, readmissions, complications, and cost of care. These results were validated at another institution.
Keywords:
Colorectal surgery
Dehydration
Ileostomy
Novel protocol
Outcome
Phone call
Readmission
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