Complication of Surgical Procedure, Ileostomy; Complications, Ileostomy Malfunction, Ileostomy - Stoma, Ileostomy Underactive
Conditions
Brief summary
Each year a large number of patients undergo ileostomy surgery, a procedure in which a portion of the small intestine is attached to a hole in the abdominal wall, allowing for digested material to pass into a disposable bag worn attached to the skin. Ileostomies are performed for the treatment of a variety of diseases of the intestinal tract, such as inflammatory bowel disease, intestinal trauma, and gastrointestinal malignancy. Of the patients that undergo ileostomy surgery, 36% will require urgent medical care within the first 30 days of surgery. Most frequently, this is a result of dehydration due to excessive ostomy output. Thus, there is potential for significant improvement of the post-operative outcomes of ileostomy patients. Implementation of an automated text messaging system, EpxOstomy, can provide a way of monitoring patient's daily ostomy output and allow for timely intervention if output is outside normal limits, providing an effective way of improving patient outcomes while simultaneously reducing healthcare costs.
Detailed description
Each year thousands of patients undergo ostomy surgery in the treatment of diseases such as colorectal cancer, Crohn's disease, diverticulitis, and ulcerative colitis. During the 30-day post-operative period, patients that undergo ileostomy have a 36.1% rate of acute healthcare encounter compared to 16.2% of patients undergoing similar surgery but with primary anastomosis. The 30-day hospital readmission rate for ileostomy patients due to dehydration and renal failure is 17%, with the median cost per colorectal surgery readmission being $8,885. Thus, there is substantial room for post-operative improvement in the care of ileostomy patients, both to reduce healthcare costs and improve patient quality of life. An automated text messaging system can provide a way to consistently monitor patients' ileostomy output, ensuring that patients are measuring their daily output as instructed and allowing for timely preemptive intervention should output be outside normal limits.
Interventions
BEHAVIORALEpxOstomy
A 30-day post-operative automated text-messaging intervention for home monitoring of ileostomy output
Sponsors
Epharmix, Inc.
St. Louis University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
All patients undergoing ileostomy surgery will receive the study intervention. We will compare to a historical control.
Eligibility
Sex/Gender
ALL
Age
18 Years to 90 Years
Healthy volunteers
Yes
Inclusion criteria
* Patients between 18-90 years of age with phone or text receiving device access. * English speaking * Patients undergoing ileostomy surgery
Exclusion criteria
* Patients who do not have phone or text receiving device access * Patients mentally unable to provide consent for the study * Patients who do not speak English
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Hospital-based acute health care encounters (HBAC) | 30 days following discharge | The percentage of patients that require a HBAC (HBAC = readmissions + emergency department visits) due to post-op complications following ileostomy surgery. Medical records will be reviewed for readmissions or ED visits within 30-days following discharge. Additionally, the final message of the automated text-message intervention asks patients if they required readmission or ED care at any non-Saint Louis University Hospital facility(s). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Patient response rates | throughout the 30 days of the intervention | Automated message response data |
| Patient satisfaction survey results | One time, on day 30 of the intervention. | Results of a patient survey administered via automated text-message after completion of the intervention. |
Countries
United States
Outcome results
None listed