Implementation of an Ileostomy Pathway Decreases Readmissions Due to Dehydration

Introduction: Approximately 40,000 new ileostomies, procedures that allow bodily waste to pass through a surgically created stoma on the abdomen, are performed yearly.1 Postoperatively, the readmission rate for ileostomy patients within the first 30 days is reported at 35%, with dehydration being the most common complication necessitating hospital readmission.2 Readmissions are costly and almost one-half are preventable3.

The focus of this project was to decrease postoperative readmissions related to dehydration for patients with new ileostomies, improving quality of care and outcomes.

Methods: A quantitative quasi-experimental design was used. The setting was a large colorectal surgery practice in an urban, academic hospital. The local IRB determined there was no risk to patient safety. Baseline data was taken from March 2019, providing comparison after implementation of the intervention. An extensive literature search was completed and existing ileostomy pathways were examined. The Beth Israel Deaconness Medical Center (BIDMC) ileostomy pathway was chosen as the model pathway to trial reduction of hospital readmissions at the project site. The major components of the BIDMC pathway include structured and detailed patient education, and strict monitoring of intake and output4. The patient education component at the site was restructured using the model. Data collection occurred from November 2020 to January 2021, and patients were followed for 30 days post-implementation of the pathway.

Results: Data on readmission rates were calculated and compared to baseline data. Prior to institution of the BIDMC pathway, 10 patients met inclusion criteria and were included in the analysis; of those 10, two required readmission (20% readmission rate). Post-pathway implementation, 13 patients met inclusion criteria, and none required readmission. A chi-square test showed a statistically significant decrease in readmission rate from the pre-intervention group (n=2, 20%) to the post-implementation group (n=0, 0.0%), X2 (1, Nf23)=3.84, p=.042.

Conclusion: Prior to the implementation of the BIDMC pathway, there was no standardized program at this institution for patient education, coordination of care, and postoperative care for ileostomy patients. Implementation of the pathway significantly eliminated preventable readmissions during the study period. Recommendations include sustaining the pathway and longer-term analysis to determine the full impact of this intervention.