Barriers to Post-Discharge Monitoring and Patient-Clinician Communication: A Qualitative Study

Brajcich, Brian C.; Shallcross, Meagan L.; Johnson, Julie K.; Joung, Rachel H.; Iroz, Cassandra B.; Holl, Jane L.; Bilimoria, Karl Y.; Merkow, Ryan P.

doi:10.1016/j.jss.2021.06.032

Cited by 11 publications

(5 citation statements)

References 15 publications

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“…To our knowledge, this is the first study to qualitatively examine the vascular surgery hospital discharge process from the perspectives of both patients and interdisciplinary healthcare team members. Previous studies involving medical and surgical patients have noted similar findings to this study, including staff perceptions of rushed discharge, interdisciplinary communication breakdown, lack of role clarity, challenges to accessing the patient's provider post‐discharge, and limited information transfer to primary care providers (Brajcich et al, 2021; Kable et al, 2019; Kattel et al, 2020; Pinelli et al, 2017). These negative discharge experiences increase the chances of poor post‐hospitalization outcomes, patient safety events, delayed outpatient care, and/or unplanned healthcare utilization, including unplanned readmissions (Jack et al, 2009).…”

Section: Discussionsupporting

confidence: 78%

Discharge process challenges of an academic vascular surgery service: A qualitative study

Doss

Vogel

Kruse

et al. 2022

Research in Nursing & Health

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Section: Discussionsupporting

confidence: 78%

Discharge process challenges of an academic vascular surgery service: A qualitative study

Doss

Vogel

Kruse

et al. 2022

Research in Nursing & Health

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“…A recently published qualitative study interviewed patients and clinicians about barriers to postdischarge continuity of care following gastrointestinal cancer operations. 19 In this study, patients remarked that they felt unprepared to handle various scenarios which arose in the postdischarge setting and additionally had difficulty establishing contact with their care team in moments of need. Additional quantitative data are necessary to truly characterize the extent of preventable ED treat-and-release visits.…”

Section: Resultsmentioning

confidence: 85%

“…It is expected that this trend would hold true for postsurgical patients, who likely rely on the ED for problems that occur after discharge when they are unable to access their surgical team in a timely or reliable fashion. A recently published qualitative study interviewed patients and clinicians about barriers to postdischarge continuity of care following gastrointestinal cancer operations 19 . In this study, patients remarked that they felt unprepared to handle various scenarios which arose in the postdischarge setting and additionally had difficulty establishing contact with their care team in moments of need.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of emergency department treat‐and‐release encounters after major gastrointestinal surgery

Brajcich

Johnson

Holl

et al. 2023

Journal of Surgical Oncology

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Background and Objectives: Emergency department (ED) utilization after gastrointestinal cancer operations is poorly characterized. Our study objectives were to determine the incidence of, reasons for, and predictors of ED treat-and-release encounters after gastrointestinal cancer operations. Methods: Patients who underwent elective esophageal, hepatobiliary, gastric, pancreatic, small intestinal, or colorectal operations for cancer were identified in the 2015-2017 Healthcare Cost and Utilization Project State Inpatient and State Emergency Department Databases for New York, Maryland, and Florida. The primary outcomes were the incidence of ED treat-and-release encounters and readmissions within 30 days of discharge.Results: Among 51 527 patients at 406 hospitals, 4047 (7.9%) had an ED treat-andrelease encounter, and 5573 (10.8%) had an ED encounter with readmission. In total, 40.7% of ED encounters were treat-and-release encounters. ED treat-and-release encounters were most frequently for pain (12.0%), device/ostomy complaints (11.7%), or wound complaints (11.4%). ED treat-and-release encounters predictors included non-Hispanic Black race/ethnicity (odds ratio [OR] 1.24, 95% confidence interval [CI] 1.12-1.37) and Medicare (OR 1.27, or Medicaid (OR 1.82, 95% CI 1.62-2.40) coverage.Conclusions: ED treat-and-release encounters are common after major gastrointestinal operations, making up nearly half of postdischarge ED encounters. The reasons for ED treat-and-release encounters differ from those for ED encounters with readmissions.

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“…Use of EHR portals among medical oncology patients varies; patients are less likely to view and send messages with their medical oncologists versus other doctors and are less likely to view cancer‐related results online 12 . Research exploring how postoperative patients communicate with their surgical oncology teams is evolving as new EHR‐integrated tools emerge 13–16 …”

Section: Introductionmentioning

confidence: 99%

“…12 Research exploring how postoperative patients communicate with their surgical oncology teams is evolving as new EHRintegrated tools emerge. [13][14][15][16] For patients undergoing surgery for colorectal cancer, bowel function has been previously shown to correlate with patients' QoL. [17][18][19][20][21][22][23] The colorectal functional outcome (COREFO) questionnaire is a validated instrument that measures patient bowel function and QoL.…”

mentioning

confidence: 99%

Electronic health record‐integrated questionnaires in colorectal surgery patients as a new standard: Could preoperative bowel function be used to predict postoperative patient‐reported outcomes?

Cai,

Blythe,

et al. 2024

Journal of Surgical Oncology

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Background and ObjectivesPatient‐reported bowel function has been previously shown to correlate with quality of life and patient‐reported outcomes (PROs) after colorectal surgery. We examined the relationship between preoperative patient‐reported bowel function and postoperative symptom reporting using an electronic health record‐integrated symptom management (eSyM).MethodsPatients who underwent major abdominal surgery for colorectal cancer at a single institution were included. Preoperative bowel function was assessed prospectively using the validated colorectal functional outcome (COREFO) questionnaire. Patients with electronic portal access received automated eSyM questionnaires after discharge. Logistic regression was used to analyze the association between COREFO scores and eSyM use.Results169 patients underwent surgery between April 2020 and June 2022 (median age 64, 46.7% female). 148 completed COREFO questionnaires preoperatively; 54 (36.5%) had scores ≥15. Of the 108 patients with portal access, 67.6% used eSyM postoperatively. Among users, 72.3% (47/73) reported severe symptoms. Those with COREFO scores ≥15 were more likely to use eSyM (80.0% vs. 62.7%) though this difference was not significant (p = 0.079).ConclusionsWe found that eSyM utilization regardless of preoperative baseline bowel function was high in this cohort of colorectal surgery patients. This suggests that electronically captured PROs is an effective way for patients to communicate symptoms to their care teams in a postsurgical setting.

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Barriers to Post-Discharge Monitoring and Patient-Clinician Communication: A Qualitative Study

Cited by 11 publications

References 15 publications

Discharge process challenges of an academic vascular surgery service: A qualitative study

Discharge process challenges of an academic vascular surgery service: A qualitative study

Evaluation of emergency department treat‐and‐release encounters after major gastrointestinal surgery

Electronic health record‐integrated questionnaires in colorectal surgery patients as a new standard: Could preoperative bowel function be used to predict postoperative patient‐reported outcomes?

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