• Deborah Nagle, Therese Pare, Emily Keenan, Kristin Marcet, Steven Tizio, and Vitaliy Poylin.
• Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. dnagle@bidmc.harvard.edu
• Dis. Colon Rectum. 2012 Dec 1; 55 (12): 1266-72.

BackgroundNew ileostomates face significant physical and psychological adaptations. Despite advanced resources, such as wound, ostomy, and continence nurses, we observed a high readmission rate for dehydration among patients with new ileostomies.ObjectiveOur goal was to create a pathway to reduce readmission and facilitate patient education and well-being.DesignThe 'Ileostomy Pathway' was established by a collaborative group at Beth Israel Deaconess Medical Center. A standardized set of patient education tools was developed to be used throughout the perioperative process. Patient's education started with the preoperative visit. All patients were directly engaged in ostomy management and trained in a stepwise progression. Patients were discharged from the hospital with flow sheets, supplies for recording intake/output, and visiting nurse services. Prospectively collected data from the first 7 months was compared with a retrospective database of the previous 4 years.SettingsThis study was conducted at a tertiary academic center.PatientsPatients with a new permanent or temporary ileostomy were included.InterventionsA new ileostomy pathway was created.Main Outcome MeasuresThe primary outcome measured was readmission rates.ResultsOne hundred sixty-one patients were assigned to prepathway implementation and 42 were assigned to postpathway implementation. One hundred three of 203 (50.7%) patients were men, and 58 of 203 (28.6%) patients had permanent ostomies. Overall readmission rate was 35.4% and 21.4% for the prepathway and postpathway groups. The readmission rate for dehydration was 15.5% (25/161) for prepathway patients, but dropped to 0% in the study group. The average length of stay after creation of the new ostomy was 7.5 days and 6.6 days for prepathway and postpathway groups.LimitationsThis study was limited by its small sample size and the lack of randomization.ConclusionsA simple, educational program for new ileostomy patients that includes preoperative teaching, standardized teaching materials, in-hospital engagement, observed management, and postdischarge tracking of intake and output is very effective in decreasing hospital readmission. The average length of stay remained stable, despite the addition of this teaching program to our perioperative/inpatient care.

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