Taking this a step further, the University of Florida has instituted a multidisciplinary pre-operative day for head and neck surgery patients. They attend pre-admission visits with the anesthesia clinic, speech language pathologists, dietician, dentistry, G-tube tube clinic (if warranted), and internal medicine clinic.
Explore This IssueOctober 2015
Addressing Quality Care
The University of Florida addresses quality care on multiple fronts, as part of its effort to prevent readmissions. Patient and caregiver satisfaction are evaluated during the hospital stay. “This is gauged with surveys or weekly quality rounds led by the physician team,” Dr. Dziegielewski said. “Areas of concern are recorded and acted upon to improve the patient/caregiver hospital experience.”
In addition, the hospital has set a goal of improving communication between the patient and care team. Simple interventions, such as placing a white board in front of a patient’s bed listing the care team members and their roles, any upcoming tests, and the patient’s daily goals, help patients to better understand their care.
Improving discharge planning and education is another priority. “Ensuring that patients and caregivers are capable of taking care of wounds, tracheostomy sites, laryngectomy stoma sites, and G-tube sites via nursing demonstrations, videos, and instructional pamphlets is important,” Dr. Dziegielewski said.
Patients or caregivers must demonstrate proper wound care procedures, as well as airway and tube feed care techniques to the nursing team prior to discharge.
Following discharge, patients are given coordinated follow-up appointments with their surgeon and appropriate ancillary health staff, such as physical therapists and speech language pathologists. Patients are called within 72 hours of discharge to monitor at-home recovery and confirm follow-up appointments. If a patient fails to attend follow-up visits, a clinic nurse will call.
Preventing Surgical Site Infections
While the percentage is low among otolaryngology surgical patients (0.06%), surgical site infection (SSI) was the most common predictor for readmission found in a study by Jain and colleagues, reported Stephanie Shintani Smith, MD, MS, assistant professor of otolaryngology-head and neck surgery at Northwestern University Feinberg School of Medicine in Chicago, and a co-author of the study (Laryngoscope. 2014;124:1783-1788). SSIs account for more than $3 billion (and up to $10 billion) in direct costs annually, according to the CDC. “Several best practice guidelines exist to help prevent SSIs,” Dr. Smith said. “They focus on appropriate timing, selection, and duration of prophylactic antimicrobial agents.
Providing Good Coverage
In private practice, physicians who cover for other physicians must have the skills to manage their patients and should have a full understanding of the patients and their individual problems, said Virginia Feldman, MD, attending physician at Orange Regional Medical Center and ENT and Allergy, both in Middletown, N.Y., and founder and CEO of Nexus Health Resources, a Middletown care management company that assists hospitals and skilled nursing facilities in reducing avoidable hospital readmissions. For complex cases, the covering surgeon must be able to reach the admitting or operating surgeon. “By having the operating surgeon answer specific questions directly, the covering physician may be able to better understand the patient’s clinical condition—as well as his needs and nuances that he may otherwise overlook,” she said.