A patient-centered early warning system to prevent readmission after colorectal surgery: a national consensus using the Delphi method.

Li LT, Mills WL, Gutierrez AM, Herman LI, Berger DH, Naik AD. A patient-centered early warning system to prevent readmission after colorectal surgery: a national consensus using the Delphi method. Journal of the American College of Surgeons. 2013 Feb 1; 216(2):210-6.e6.

Related HSR&D Project(s)

• RRP 12-532 – Formative Evaluation of Veteran-Centered Post-Surgical Discharge Intervention

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Abstract:

BACKGROUND: Warnings of deteriorating condition provided to patients at hospital discharge are highly subjective, based on conventional wisdom, and lack systematic implementation. We conducted a standardized Delphi process to achieve national consensus on warning indicators and recommended action plans for patients after colorectal surgery. STUDY DESIGN: Expert panel eligibility was determined by pre-established criteria. A preliminary meeting was held at a national surgical conference followed by 5 rounds of email questionnaires and 1 teleconference using the Delphi method. Consensus was defined when at least 70% of the experts rated a symptom as 4 or more on a 5-point Likert scale (agree or strongly agree). RESULTS: Eleven experts were recruited to participate in the national consensus panel. A consensus was reached at Round 5. Experts identified 10 symptoms that indicate patients should notify their physician: "wound drainage," "wound opening," "wound redness or changes in the skin around the wound," "no bowel movement or lack of gas/stool from an ostomy for more than 24 hours," "increasing abdominal pain," "vomiting," "abdominal swelling," "high ostomy output and/or dark urine or no urine," "fever greater than 101.5°F," and "not being able to take anything by mouth for more than 24 hours." Two additional symptoms should alert the patient to seek emergency care: "shortness of breath or inability to breathe" and "chest pain." CONCLUSIONS: Expert consensus on discharge warning signs and appropriate action plans are identified for patients after colorectal surgery. The result of this study will help develop a more sophisticated patient-centered discharge tool for surgical patients.