The Ostomy Files: Connecting the Disconnect Between Hospital and Home

   Mr. D, 76 years old, underwent a colostomy in a local hospital after several weeks of preoperative outpatient radiation therapy that caused severe diarrhea. The nurses at the hospital managed his colostomy and told him he probably "would not need to wear a pouch" after he was taught how to irrigate.

They showed him how to empty a two-piece system before he was discharged 7 days after his surgery. Mr. D was able to manage emptying but did not pay much attention to the procedure because he viewed wearing the pouch as a temporary situation. After his discharge, the home care nurse informed him that due to the diarrhea he was experiencing, colostomy irrigation would not be an option and he would have to use a pouching system - one different from the one he had learned to use in the hospital. Mr. D was disappointed and bewildered.

   Mr. D's situation, unfortunately, is not unusual. Ostomy patients often receive mixed messages from clinicians in different settings that can lead to confusion and anxiety as well as "incontinuity" of care. Eventually, these problems segue into increased costs and prolonged rehabilitation. Written instructions, patient education materials, supplies, and discharge information prepared in the hospital often do not make it to the patient's home. Not only is this disruptive to the patient and family, but it also reduces the quality of care and impairs outcomes. As we move through the restructuring of our healthcare system, hospitals and home health agencies must establish creative and collaborative ways to provide seamless care within and across care settings. One option is to create partnerships in cross-setting care. An excellent starting point is the care and teaching of ostomy patients.

   Ostomy supplies, care protocols, teaching plans, and patient education tools should be standardized between hospitals and the home health agencies to whom they most frequently refer. Processes must be established to guarantee one constant and consistent message to ensure that teaching, discharge materials, and supplies always make it from the hospital to the patient's home. Nursing and physician staffs must be educated and their skills updated to reflect established, standardized protocols of care and patient teaching plans, as well as to reinforce hands-on competence with the ostomy supplies used within and across the organizations.

   Administrators of both hospitals and home health agencies must be willing to step away from their myopic, insular, in-house approaches and critically evaluate the impact of the current "as-is" of the systems and processes involved in moving ostomy patients out of the hospital to their homes. It may not be necessary for a hospital and a home health agency to enter into a formal business partnership; rather, creating a less formal partnership in quality ostomy care may be more beneficial. Both organizations must view the situation not only from a cost and competitive standpoint, but also from the perspective of its effect on their mutual patients and their families. What impact does the current disconnect of ostomy information, processes, and procedures have on the patient? How does this disconnect affect the time it takes for a new ostomy patient to master self-care? Implementing and marketing innovative and collaborative arrangements between hospitals and home care agencies could improve competition, reduce exposure to medical liability, and be a win-win situation for all vested parties.

   Patients can reap many benefits from such a partnership through returns on improved outcomes and quality of care, and possibly, more rapid integration back into the community. Hospitals and home health agencies also benefit through improving their referral sources, saliently marketing the value they place on continuous education and quality improvement of their employees, increasing the ability to compete in a very competitive marketplace, improving outcomes of care, and possibly compressing rehabilitation time for new patients. Each of these steps helps reduce costs and elevates the level of knowledge and competence of all the stakeholders. Efficiency improves quality, quality improves outcomes, and improved outcomes enhance the bottom line for everyone. Such a partnership in ostomy care promotes teamwork, interdisciplinary collaboration, and professional growth and reinforces the individual responsibility of each employer and employee to deliver meaningful ostomy care and rehabilitation.

   The Ostomy Files is made possible through the support of ConvaTec, A Bristol-Myers Squibb Company, Princeton, NJ.