Upper Extremity Infections, Immediate Interventions After Surgery to Reduce Readmission
Alec H. Fisher, Zachery J. Nelson, Nicole J. Jarrett, Rey Ramirez, David Fuller, Michael J. Franco
Cooper University Hospital, Camden, NJ
Background: Patients with upper extremity infections (UEI) are difficult to treat. Challenges in socioeconomics, support, access to care and disease may result in patients over utilizing emergency care, require additional surgery and increase hospital expenditures. Our team believes formally educating patients and engaging hand therapists early can improve follow-up, increase therapy attendance, reduce emergency room visits and improve functional outcomes for patients requiring operative management of upper extremity infections.
Methods: This IRB approved, two-phase study aims to investigate and intervene on the pathway for patients requiring surgery for UEI at a single institution. The first phase, over six months, patients with UEI requiring surgery received standard of care, including: written discharge instructions, a follow-up and then a determination for hand therapy based on office evaluation. For the second phase, over the next six months, all patients with UEI requiring surgery received additional interventions along with the standard of care. New interventions included: a scripted educational session prior to discharge by a surgical resident, home exercise program instructions with pictures and an immediate referral to hand therapy prior to discharge. Outcome measures assessed for six months following discharge were clinic follow-up attendance, hand therapy attendance, ER visits for the same complaint, readmissions, and reoperations.
Results: This study is still enrolling patients in the intervention group (n=25) and following the non-intervention group (n=43). Preliminary analysis of the non-intervention group shows 20 of 43 (46.5%) have attended a follow-up appointment, 1 of 43 (2.3%) have attended hand therapy, and 9 of 43 (20.9%) have presented to the ER after surgery, resulting in 7 admissions for complications from surgery and 2 of 7 readmitted required a second operation. In the intervention group, 8 of 16 (50%) have attended a follow-up appointment, 6 of 25 (24%) have attended hand therapy, and 3 of 25 (12%) have presented to the ER and were readmitted, but neither required additional surgery.
Conclusion: We believe this early and simple intervention may prove to be an effective way to improve care for a challenging population of patients. Thus far in the non-intervention group, 20% of patients returned to the emergency and 2.3% attended hand therapy post operatively. In comparison, 24% in the intervention group have gone to hand therapy and 12% have returned to the emergency room. Although data is incomplete, we believe this intervention decreases ER burden and results in better management of patients requiring surgical management of UEI.
Back to 2021 Abstracts