Problem Detailing
Local Issue
The #1 reason for ED/readmission during the first 30 days following bariatric surgery was dehydration at our site.
Problem Statement
The number of Emergency Department visits and readmissions within 30 days of bariatric surgery had one commonality; The patients were dehydrated. From June 2016 to November 2016, we had an ED/readmission rate for dehydration of 12.05%.
Aim Specification of QI Project
SMART Goal
Thirst after surgery was causing our patients to gulp their liquids too quickly. This caused an “overfilling” of their pouch/sleeve which often resulted in vomiting, poor fluid intake, or both. Our ED/readmission rate for dehydration was 12.05%. With introduction of the sippy cup and better instruction on fluid intake, our goal was to reduce this to at least half or 6%.
Strategic Planning
Description of QI Activity
Planned education and introduction of a sippy cup to patients in preop class began in December 2016. Followed MBSAQIP data for the 6 months following this introduction and reported outcomes.
Description of Intervention
- 12/2016 our preop class began to focus on hydration after surgery, because patients needed to understand the anatomy of their stomach after surgery and understand why they could no longer gulp down large quantities of fluids postop.
- A 10oz. spill proof sippy cup was provided to the patients during the preop class, with instructions to practice sipping at home prior to surgery. Limiting the amount patients sip from the cup helped in teaching them the quantity the sleeve/pouch can hold, while also assisting them with their thirst following surgery.
- Bariatric floor staff were educated regarding hydration following surgery as well as when to encourage the sippy cup. Once the floor staff understood the size of the “new” stomach, it was easier to comprehend the need to sip, not gulp.
- Discharge education reminded patients of the need to stay hydrated and drink at least 60 oz. of fluid per day (or 6 sippy cups). If the patient continued the practices followed in the hospital, they are less likely to become dehydrated.
Improvement Team
MBS Direct, MBS coordinator, MBSCR, Dietary, and bariatric floor staff
Outcome Evaluation
Intervention Data
From December 2016 through May 2017 our ED/readmission rate for dehydration decreased to 5.2%.
Final or Most Current Results
Our current ED/readmission rate for 2022–2023 is 1.3%.
Limitations/Setback
One limitation/setback we found was patients would forget to pack their sippy cup to bring to the hospital on their surgery date.
Cost, Resources, and Value Evaluation
Cost of Project
Each sippy cup was approximately $0.88, so about $1 per patient.
Team and Stakeholders’ Perspective on Value
Great outcome with very little expense. This appeared to be a simple fix to what could be a costly problem. The reduction in ED/readmission rates by 7.24% in a 6-month period was great. This simple QI project continues to have great outcomes.
Resources Used
MBSAQIP Database
Knowledge Acquisition
Key Takeaways
Sometimes a big problem can be solved with common sense.
- Listen to the patient and think about, “Why is this happening?”
- Once the “Why” is figured out, come up with a solution.
- Don’t be afraid to try solutions “outside of the box.” We immediately try to think of medications to decrease nausea and vomiting. The “why” (drinking fluids faster that our stomach can tolerate) is just as important and a much simpler fix.
- Use “common sense” regardless how simple a solution seems. The outcome is what is important.
End-of-Project Decision-Making
Future Actions
Since this project, we have increased our preop education and now have simplistic images of what the postop bariatric stomach looks like with fluids going into it. The visual has really helped our patients understand what happens when they drink too fast or too much.
Post-Project Plan
This project continues to be part of our bariatric plan of care.
