BACKGROUND: Warnings of deteriorating condition provided to patients at hospital discharge are highly subjective, based on conventional wisdom, and lack systematic implementation. We conducted a standardized Delphi process to achieve national consensus on warning indicators and recommended action plans for patients after colorectal surgery. STUDY DESIGN: Expert panel eligibility was determined by pre-established criteria. A preliminary meeting was held at a national surgical conference followed by 5 rounds of email questionnaires and 1 teleconference using the Delphi method. Consensus was defined when at least 70% of the experts rated a symptom as 4 or more on a 5-point Likert scale (agree or strongly agree). RESULTS: Eleven experts were recruited to participate in the national consensus panel. A consensus was reached at Round 5. Experts identified 10 symptoms that indicate patients should notify their physician: "wound drainage," "wound opening," "wound redness or changes in the skin around the wound," "no bowel movement or lack of gas/stool from an ostomy for more than 24 hours," "increasing abdominal pain," "vomiting," "abdominal swelling," "high ostomy output and/or dark urine or no urine," "fever greater than 101.5°F," and "not being able to take anything by mouth for more than 24 hours." Two additional symptoms should alert the patient to seek emergency care: "shortness of breath or inability to breathe" and "chest pain." CONCLUSIONS: Expert consensus on discharge warning signs and appropriate action plans are identified for patients after colorectal surgery. The result of this study will help develop a more sophisticated patient-centered discharge tool for surgical patients.
BACKGROUND: Warnings of deteriorating condition provided to patients at hospital discharge are highly subjective, based on conventional wisdom, and lack systematic implementation. We conducted a standardized Delphi process to achieve national consensus on warning indicators and recommended action plans for patients after colorectal surgery. STUDY DESIGN: Expert panel eligibility was determined by pre-established criteria. A preliminary meeting was held at a national surgical conference followed by 5 rounds of email questionnaires and 1 teleconference using the Delphi method. Consensus was defined when at least 70% of the experts rated a symptom as 4 or more on a 5-point Likert scale (agree or strongly agree). RESULTS: Eleven experts were recruited to participate in the national consensus panel. A consensus was reached at Round 5. Experts identified 10 symptoms that indicate patients should notify their physician: "wound drainage," "wound opening," "wound redness or changes in the skin around the wound," "no bowel movement or lack of gas/stool from an ostomy for more than 24 hours," "increasing abdominal pain," "vomiting," "abdominal swelling," "high ostomy output and/or dark urine or no urine," "fever greater than 101.5°F," and "not being able to take anything by mouth for more than 24 hours." Two additional symptoms should alert the patient to seek emergency care: "shortness of breath or inability to breathe" and "chest pain." CONCLUSIONS: Expert consensus on discharge warning signs and appropriate action plans are identified for patients after colorectal surgery. The result of this study will help develop a more sophisticated patient-centered discharge tool for surgical patients.
Authors: Robert W Krell; Micah E Girotti; Danielle Fritze; Darrell A Campbell; Samantha Hendren Journal: J Am Coll Surg Date: 2013-12 Impact factor: 6.113
Authors: Aanand D Naik; Molly J Horstman; Linda T Li; Michael K Paasche-Orlow; Bryan Campbell; Whitney L Mills; Levi I Herman; Daniel A Anaya; Barbara W Trautner; David H Berger Journal: J Am Med Inform Assoc Date: 2017-09-01 Impact factor: 4.497
Authors: Aaron R Scott; Elizabeth A Alore; Aanand D Naik; David H Berger; James W Suliburk Journal: JMIR Mhealth Uhealth Date: 2017-02-08 Impact factor: 4.773
Authors: Molly J Horstman; Whitney L Mills; Levi I Herman; Cecilia Cai; George Shelton; Tareq Qdaisat; David H Berger; Aanand D Naik Journal: BMJ Open Date: 2017-02-22 Impact factor: 2.692