QI program cuts readmissions after bariatric surgery

Last Updated: 2016-11-07

By Megan Brooks

NEW YORK (Reuters Health) - A quality improvement (QI) initiative has significantly cut readmissions after bariatric surgery.

On average, participating hospitals saw 30-day readmission rates for bariatric surgery patients drop by about 14%. Some hospitals reduced their readmission rates by more than 30%, according to research presented November 2 in New Orleans at ObesityWeek 2016, co-sponsored by the American Society for Metabolic and Bariatric Surgery (ASMBS) and The Obesity Society (TOS).

"Readmissions are of interest to both the patient, the payer and obviously the surgeon, so it incorporates cost and satisfaction," study chief Dr. John M. Morton, director of bariatric surgery at Stanford Hospital and Clinics in Palo Alto, California and immediate past-president of the ASMBS, noted in an interview with Reuters Health.

"Weight-loss surgery has already become one of the safest operations in America, comparable to gallbladder and joint replacement surgery, but we saw readmissions as an area we could improve even further," he added in a news release. "Through a true collaboration among hospitals and centers, we bundled best pre-operative and post-operative programs and practices that focused on key triggers for readmissions, taking advantage of a bariatric program's multi-disciplinary approach."

Many bariatric surgery readmissions stem from preventable causes such as nausea, vomiting, and electrolyte and nutritional depletion, Dr. Morton explained. The Decreasing Readmissions through Opportunities Provided (DROP) program targets these issues.

The program includes multiple interventions but "two interventions really stood out," Dr. Morton said.

"One was calling the patient after discharge. That's important because you can find out if there is a problem or a misunderstanding and clear it up," he explained.

"The other was seeing a nutritionist at the postop visit. This gives the patient an opportunity to get further instruction around their diet. Dietary changes are a very large component of bariatric surgery recovery so getting patients to understand this is critical," he said. Patients also have a visit with a nutritionist during their hospital stay.

Other interventions include an educational video shown to patients before the surgery that covers different aspects of recovery; giving patients their postop pain medications before discharge; making sure the patient has a postop appointment before discharge; and providing patients with a help card noting when they need to call (for fever, pain, dehydration, etc) and providing a direct line to the clinic.

The DROP program was implemented by 128 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Comprehensive Centers between March 2015 and March 2016 for patients undergoing primary laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy, or laparoscopic Roux-en-Y gastric bypass.

In the year prior to the program, participating centers had a 30-day readmission rate of 4.79% with 1,446 readmissions from 30,204 cases. Six months after implementing the DROP program, the readmission rate had fallen by an average of 14%. The reduction in readmissions was 32% for hospitals in the top quartile of readmissions before the starting the program.

"The project was highly successful," Dr. Morton told Reuters Health. "We saw significant declines in 30-day readmissions - particularly the ones that were preventable from dehydration and dietary indiscretions. And we saw the biggest decrease around the sleeve gastrectomy. We applied the program to all the procedures but the sleeve gastrectomy was the one that had the biggest decline," he noted.

"The take-home from all of this is that when you have coordination of care, you have a shared purpose, you're able to do this. The other thing that was interesting about the study is that we had 128 hospitals and we never met in person. We did this all through webinars, through check lists, and people collecting their data," Dr. Morton said.

"The highest quality care in bariatric surgery is occurring at MBSAQIP accredited centers," Dr. Samer G. Mattar, a bariatric surgeon and professor of surgery at Oregon Health and Science University (OHSU) in Portland, who was not involved in the study, said in the news release. "This study shows that we can harness the best practices that are occurring in these institutions and spread them throughout the country for the benefit of our patients."

SOURCE: http://bit.ly/2fvWewb

ObesityWeek 2016.