Identification of Process Measures to Reduce Postoperative Readmission

Amy L. Halverson, Morgan M. Sellers, Karl Y. Bilimoria, Mary T. Hawn, Mark V. Williams, Robin S. McLeod, Clifford Y. Ko

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Background: Readmission rates after intestinal surgery have been notably high, ranging from 10 % for elective surgery to 21 % for urgent/emergent surgery. Other than adherence to established strategies for decreasing individual postoperative complications, there is little guidance available for providers to work toward reducing their postoperative readmission rates. Study Design: Processes of care that may affect postoperative readmissions were identified through a systematic literature review, assessment of existing guidelines, and semi-structured interviews with individuals who have expertise in hospital readmissions and surgical quality improvement. Eleven experts ranked potential process measures for validity on the basis of the RAND/University of California, Los Angeles Appropriateness Methodology. Results: Of 49 proposed process measures, 34 (69 %) were rated as valid. Of the 34 valid measures, two measures addressed care in the preoperative period. These included evaluation of patient's comorbidities, providing written instruction detailing the anticipated perioperative course, and communication with the patient's referring or primary care doctor. A measure addressing perioperative care stated that institutions should have a standardized perioperative care protocol. Additional measures focused on discharge instructions and communication. Conclusions: An expert panel identified several aspects of care that are considered essential to quality patient care and important to reducing postoperative readmissions.

Original languageEnglish
Pages (from-to)1407-1415
Number of pages9
JournalJournal of Gastrointestinal Surgery
Issue number8
StatePublished - Aug 2014

Bibliographical note

Funding Information:
Funding This study was supported by funding from the Nora Institute for Surgical Patient Safety.


  • Discharge planning
  • Hospital readmission
  • Patient communication
  • Postoperative complication
  • Preoperative assessment
  • Process measures

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology


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