Identification of Local Problem
Navigating the health system after serious illness and emergency general surgery (EGS) is challenging for patients.
Context of the QI Activity
We initiated a pilot study to examine trends after implementing a navigator program with the goal to strengthen patient compliance for outpatient follow up and care.
What were the interventions
We created an EGS Navigator program at our tertiary medical center to provide consistent follow up care in patients who required prolonged total parenteral nutrition (TPN), had complex wounds or surgical drains, required fistula management, or had conditions involving frequent outpatient or multidisciplinary appointments. A medical assistant offered support to patients via frequent telephone calls to ensure timely in-office follow-up with the surgical team and consultants, and helped facilitate patient needs following discharge. A prospective evaluation of patients enrolled in the program was performed. Demographic and hospital readmission data were collected and reported.
Cost and Funding Sources
There were no costs associated with this project.
Overall Results and Analysis
A total of 59 patients were enrolled in the program. Patients were contacted by the navigator anywhere from 0-5 times after discharge. The most common comorbidities were diabetes (37.3%), CKD (22%), and CAD (16.9%). Median hospital length of stay was 15 (Q1 7, Q3 38) days. There were 24 (40%) patients who required TPN during their hospitalization, of which 6 (10.2%) were discharged on TPN. Of the cohort, 17 (28.8%) patients experienced hospital re-admission. Common reasons for re-admission were-intrabdominal abscess (6.8%) and subcutaneous abscess/surgical site infection (10.2%).
Limitations
This was a single center pilot study. Expanding the navigator program would allow for a broader understanding of its impact on patients and the healthcare system. We focused primarily on EGS patients. Our results cannot be applied to other subspecialities but literature has demonstrated success in implementing navigator programs in other domains such as oncology and orthopedics.
Lessons Learned
Navigating complex post-surgical care can be difficult for EGS patients resulting in multiple re-admissions to the hospital. Surgical Navigators have been found to be helpful in reducing readmission rates, emergency department visits and delay of care in other surgical patients and may be equally beneficial for EGS patients. Further study of long-term outcomes of surgically complex EGS patients with a comparator group is needed to determine the clinical utility of this role.
