Reduction in Post-Discharge Return to Acute Care in Hepatopancreatobiliary Surgery: Results of a Quality Improvement Initiative.

ABSTRACT Introduction Postoperative returns to acute care represent fragmented care, are costly, and often evolve into readmission. Reduction of postoperative readmissions and emergency department (ED) visits represents an opportunity to improve quality of care and decrease resource utilization. The aim of this study was to assess the impact of two FMEA-guided quality improvement (FQI) interventions on return to acute care within 30 days postoperatively. Methods An ACS NSQIP database analysis of adult patients treated by a single hepatopancreatobiliary surgeon at a quaternary academic center was performed. Two FQI interventions were assessed in a staged fashion, including 1) a post-discharge phone call follow-up, and 2) a pre-operative clinic visit to discuss plans of care. The primary outcome of interest was return to acute care (readmission or ED utilization) within 30 days from postoperative discharge. Results During the 4-year study period, 684 patients underwent an HPB operation. Following the implementation of the FMEA interventions, the baseline 30-day readmission rate was reduced by 48% post-intervention (13.5 vs. 6.9%, p=0.011). This impact was sustained, with a readmission rate below the lowest baseline in 5 of 6 post-intervention quarters. Short-stay readmissions were reduced by over 76% following the interventions (28.5% vs. 6.6%). Post-discharge emergency department visits were also reduced by nearly 40% following initiation of both FQI interventions (11.3% vs. 6.9%; p=0.125), which showed similar sustained response. Discussion The results from this study can be used to help identify, develop, and test interventions to optimize ED utilization and readmission to reduce healthcare costs and improve patient quality of life.