Improved Outpatient Communication Decreases Unplanned Readmission in Necrotizing Pancreatitis

Thomas K. Maatman, Kathleen A. McGreevy, Andrew J. Sood, Eugene P. Ceppa, Michael G. House, Attila Nakeeb, C. Maximilian Schmidt, Trang K. Nguyen, Nicholas J. Zyromski

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Abstract

Background: Unplanned readmission rates in necrotizing pancreatitis (NP) are among the highest of any medical disease (72%). Recent work has identified several potentially preventable causes of unplanned readmission in NP. We hypothesized that intensive outpatient communication would identify developing problems and decrease unplanned hospital readmission. Materials and methods: A review of NP patients treated at a single institution between 2016 and 2019 compared patients 2 y before (NP-pre, 2016-2018) and 1 y after (NP-post, 2018-2019) the establishment of a dedicated pancreatitis nurse coordinator. Unplanned hospital readmission and emergency room visits were compared between groups. Results: A total of 178 NP patients were treated—112 patients in the NP-pre group and 66 patients in the NP-post group. No differences between groups were observed in age, sex, comorbidities, pancreatitis etiology, NP severity, or mortality. A mean of 5.4 ± 0.2 outpatient communications per patient with the pancreatitis nurse coordinator was documented in the NP-post group. Unplanned readmission rates decreased significantly from 64% (NP-pre) to 45% (NP-post; P = 0.02). The frequency of readmission decreased from 1.6 readmissions per patient (NP-pre) to 0.8 readmissions per patient (NP-post; P = 0.001). Readmissions because of symptomatic necrosis, failure to thrive, nonnecrosis infection, and drain dysfunction decreased (P < 0.05). Overall disease duration was similar (NP-pre, 4.6 ± 0.3 mo; NP-post, 5.0 ± 0.3 mo; P = 0.4); however, the mean number of unplanned inpatient days decreased from 15.4 ± 2.2 d (NP-pre) to 7.8 ± 1.6 d (NP-post; P = 0.02). Conclusions: Improved outpatient communication identifies treatable problems and significantly decreases unplanned readmission in NP patients.

Original languageEnglish (US)
Pages (from-to)139-146
Number of pages8
JournalJournal of Surgical Research
Volume253
DOIs
StatePublished - Sep 2020

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Keywords

  • Acute necrotizing
  • Continuity of patient care
  • Cost savings
  • Pancreatitis
  • Patient care team
  • Patient readmission
  • Patient satisfaction

ASJC Scopus subject areas

  • Surgery

Cite this

Maatman, T. K., McGreevy, K. A., Sood, A. J., Ceppa, E. P., House, M. G., Nakeeb, A., Schmidt, C. M., Nguyen, T. K., & Zyromski, N. J. (2020). Improved Outpatient Communication Decreases Unplanned Readmission in Necrotizing Pancreatitis. Journal of Surgical Research, 253, 139-146. https://doi.org/10.1016/j.jss.2020.03.034