To call or not to call? Discharged patients may be either extremely reluctant or far too eager to reach out to their surgeons once they're home and experiencing real or perceived post-operative symptoms. How helpful would it be if they knew exactly which developments warranted further communication, and which didn't?
At our facility, what began as an adjunct to a practice bundle designed to reduce colon surgical site infections has evolved into an easy-to-understand patient teaching tool that helps us achieve that goal.
One of our initial concerns for the bundle was that we wanted it to be evidence-based. While researching literature to find specific needs and strategies for post-operative patient teaching and post-discharge follow-up, I came across a thought-provoking study in the Journal of the American College of Surgeons (osmag.net/VTygZ8). By using a method called the Delphi technique, in which a panel of experts establishes a consensus, a group of 11 experts had developed an early-warning system to prevent readmissions after colorectal surgery.
Consensus was defined as having been reached when at least 70% of the experts rated a symptom as 4 or 5 on a 5-point Likert scale (ranging from 1, meaning "strongly disagree," to 5, meaning "strongly agree"). The experts identified 10 symptoms that indicate to patients that they should call their physicians and 2 additional symptoms that should alert patients to seek emergency care.
12 WARNING SIGNS
Call your physician if you experience:
- Wound drainage
- Wound opening
- Wound redness or changes in the appearance of the surrounding skin or around the ostomy
- No bowel movement or no gas/stool from rectum for more than 24 hours
- Increased abdominal pain
- Abdominal swelling
- High ostomy output and/or dark urine or no urine
- Fever greater than 101.5 ?F
- Inability to take anything by mouth for more than 24 hours
Go to the emergency department if you:
- Have shortness of breath or are unable to breathe
- Have chest pain
I thought, why not communicate those concepts in patient-centric language on a take-home card? We could introduce and review the 12 warning signs with the patient and the patient's family before discharge. Then, as part of the post-discharge follow-up phone call, a nurse would review the signs again and field any questions.
The goal is to deliver the best patient care by triaging post-operative issues and by confining emergency department visits to those that are true emergencies.