Healthcare News & Insights

Keys to preventing readmissions after surgery

New research attempts to shed light on the most common reasons patients are readmitted post-surgery, and how hospitals can nip the issue in the bud. 

GettyImages_178384153In a study recently published in the Journal of the American Medical Association (JAMA), a team of researchers looked at readmission rates after surgical procedures overall, as well as rates for several specific surgeries. The goal was to determine what sorts of problems caused complications requiring unexpected readmission.

Information was pulled from the American College of Surgeons National Surgical Quality Improvement Program. The program tracks the primary reason for a patient’s readmission, which helped researchers figure out whether the subsequent hospital visit was related to the person’s initial condition.

After looking at the data for close to 450 hospitals over a year-long period, researchers found that the number one reason for patients to be readmitted to the hospital after surgery was experiencing a surgical site infection. The second reason: an obstruction or ileus.

Surgical site infections and obstructions were the top contributors to both early readmissions (those that happened within seven days of the procedure) and later readmissions.

Other causes of readmission within 30 days of a surgical procedure included:

  • dehydration/nutritional deficiency
  • bleeding/anemia
  • venous thromboembolism, and
  • prosthesis or graft issues.

With most surgeries, researchers said, patients were readmitted because of a complication arising after surgery, not because the condition they were having treated got worse. And unlike 30-day readmissions for nonsurgical reasons, outside factors such as socioeconomic differences play a smaller role in whether a patient needs to be readmitted.

Many of these complications are “expected,” which means surgeons know in advance that they are likely side effects patients will experience when getting certain procedures done.

Strategy for prevention

Since the readmissions rate post-surgery is affected by different factors than readmissions for other conditions, hospitals need to take a different approach when it comes to reducing patients’ risk.

A JAMA analysis gives hospital executives some ideas about how they can approach this. Because it’s easier to anticipate the complications that cause readmission after surgery, hospitals can use a systemized approach to preventing them in the first place. The first step here is to identify weaknesses in the surgical process and focus on correcting them.

To do this most effectively, a facility may need to change its culture – specifically, its attitude toward mistakes.

Instead of blaming the clinician or surgeon for making a mistake that contributed to a patient’s complication, it’s important to examine how to tweak your process so it’s harder for anyone to make that mistake. Promoting transparency without punishing someone for admitting an error can work wonders for creating safer protocol for surgery.

Another thing to keep in mind: Harm doesn’t have to be inevitable. Hospitals with the best results in reducing post-surgical complications operate under the mindset that their goal is to achieve zero complications after surgery. All decisions are made with that objective in mind.

Because it’s easier for facilities to pinpoint just what causes a complication after surgery, it’s also easier for them to come up with a policy to target that particular issue.

And it’s key to get buy-in for these changes from the entire team, from surgeons to the top brass. Hospital executives must work closely with clinicians, doctors and nurses to reduce the likelihood of complications after surgery.

Successful teams received regular training to identify problems and implement solutions. They also got together frequently to discuss their progress and tweak their approach.

Ultimately, while it may be difficult to prevent every complication causing readmission after surgery, hard work and commitment can cause a facility’s rates to decline significantly.

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