System-Wide Improvement for Transitions After Surgery: The SWIFT Post op Program (SWIFT)
2017年12月27日 更新者：University of Minnesota
Short-term post-operative complications after colon and rectal surgery present a known major clinical and financial burden for patients and hospitals.
Focused efforts to reduce readmissions after colorectal surgery is one potentially high-yield and broad approach to address this problem since post- operative complications are the strongest predictor of readmissions.
We focus on decreasing readmissions after ileostomy surgery by using a previously published intervention that prevents dehydration in the outpatient setting and decreases acute renal failure complications.
We plan to introduce the SWIFT post op program for ileostomy patients at one academic and two community hospitals which are part of a single health care system, and to then randomize patients to usual care in the setting of this new program versus an aggressive compliance surveillance and improvement strategy (CSIS) strategy using study personnel.
Our primary study outcome is all-cause 30-day readmission, and our secondary outcomes include patient satisfaction (CAHPS scores) and a cost-benefit analysis.
We seek to create a partnership between colorectal surgeons, inpatient nurse managers and wound ostomy continence nurses (WOCN) at the three sites, linking them with outpatient nurse practitioners and physician's assistants at the respective colorectal surgery clinics who facilitate care-transition after hospital discharge.
研究概览
详细说明
At the start of the study, inpatient and outpatient nurses, physicians and physicians assistants will be oriented to the intervention in the study and will be suggested that the intervention is standard of care based on the following study:
Nagle D, Pare T, Keenen E, Marcet K, Tizio S, Poylin V*. Ileostomy Pathway Virtually Eliminates Readmissions for Dehydration in New Ostomates. Diseases of the Colon and Rectum 2012; 55: 1266-1272.
The intervention patients will be subject to a compliance surveillance and intervention strategy (CSIS) administered by study personnel to encourage the following and persist with telephone calls if the following have not been achieved.
- Prospective audits by study personnel to check and encourage teaching in the clinic, teaching on the wards, and telephone follow up occurred.
- A self-assessment tool for patients and families to confirm understanding of the education materials.
- Coaching of inpatient nurses taking care of ileostomy patients by WOCN and/or the inpatient nurse champion
- Call from the clinic nurse practitioner or physician's assistant within 7 days of discharge to review the educational materials and administer a screening questionnaire to identify patients at risk of dehydration. In patients randomized to CSIS, study personnel will ensure this phone call is made.
The usual care arm will include no such surveillance.
The randomized study will be powered to detect a decrease in hospital readmission rates (all-cause) from 25% to 5%. Secondary outcomes include readmission due to dehydration and patient satisfaction (Surgical-CAHPS survey)
研究类型
介入性
注册 (实际的)
100
阶段
- 不适用
联系人和位置
本节提供了进行研究的人员的详细联系信息，以及有关进行该研究的地点的信息。
学习地点
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Minnesota
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Minneapolis、Minnesota、美国、55455
- University of Minnesota Medical Center -Fairview
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Saint Paul、Minnesota、美国、55114
- Colon and Rectal Surgery Associates
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参与标准
研究人员寻找符合特定描述的人，称为资格标准。这些标准的一些例子是一个人的一般健康状况或先前的治疗。
资格标准
适合学习的年龄
18年 及以上 (成人、年长者)
接受健康志愿者
不
有资格学习的性别
全部
描述
Inclusion Criteria:
- Patients who are scheduled or who undergo ileostomy alone or as part of a multiple procedure operation
- patients who have had an ileostomy in the past are eligible
- patients who have an ileostomy to address a recent surgical complication are eligible
Exclusion Criteria:
- Patients who have an ileostomy already in place immediately prior to the procedure (ie. revision, transposition, or parastomal hernia procedures
- patients on dialysis
- patients who require chronic TPN, IVF, or have short gut
- non-English speaking patients who do not have easy access to an appropriate interpreter.
学习计划
本节提供研究计划的详细信息，包括研究的设计方式和研究的衡量标准。
研究是如何设计的？
设计细节
- 主要用途：预防
- 分配：随机化
- 介入模型：并行分配
- 屏蔽：双倍的
武器和干预
参与者组/臂 |
干预/治疗 |
|---|---|
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实验性的：compliance surveillance
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External monitor to ensure compliance with an educational protocol.
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无干预：Usual Care
educational session at the start of the study
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研究衡量的是什么？
主要结果指标
结果测量 |
大体时间 |
|---|---|
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Readmission to the hospital
大体时间：30 days after hospital discharge
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30 days after hospital discharge
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次要结果测量
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
|
Patient satisfaction
大体时间：3-6 months after surgery
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S-CAHPS
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3-6 months after surgery
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Index length-of-stay
大体时间：Index length-of-stay
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Time from surgical date to hospital discharge
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Index length-of-stay
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Emergency room visit
大体时间：30 days after hospital discharge
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Emergency room visits for any reason 30 days after surgery
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30 days after hospital discharge
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Total hospital-length-of-stay
大体时间：30 days after hospital discharge
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Total hospital length of stay for any reason after surgery
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30 days after hospital discharge
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Readmission due to dehydration or acute renal failure
大体时间：30 days after hospital discharge
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Dehydration by clinician assessment, acute renal failure defined as elevation in creatinine to >2 mg/dl, or oliguria/anuria
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30 days after hospital discharge
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Post-discharge follow up phone call
大体时间：30 days after hospital discharge
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Nurse, physician, or physician-assistant documentation of phone call to the patient that describes monitoring of ileostomy output volume
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30 days after hospital discharge
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合作者和调查者
在这里您可以找到参与这项研究的人员和组织。
调查人员
- 首席研究员：Mary R Kwaan, MD、University of Minnesota
研究记录日期
这些日期跟踪向 ClinicalTrials.gov 提交研究记录和摘要结果的进度。研究记录和报告的结果由国家医学图书馆 (NLM) 审查，以确保它们在发布到公共网站之前符合特定的质量控制标准。
研究主要日期
学习开始 (实际的)
2014年10月1日
初级完成 (实际的)
2016年6月1日
研究完成 (实际的)
2016年11月11日
研究注册日期
首次提交
2015年9月3日
首先提交符合 QC 标准的
2015年9月3日
首次发布 (估计)
2015年9月7日
研究记录更新
最后更新发布 (实际的)
2017年12月29日
上次提交的符合 QC 标准的更新
2017年12月27日
最后验证
2017年12月1日
更多信息
此信息直接从 clinicaltrials.gov 网站检索，没有任何更改。如果您有任何更改、删除或更新研究详细信息的请求，请联系 register@clinicaltrials.gov. clinicaltrials.gov 上实施更改，我们的网站上也会自动更新.
compliance surveillance and improvement strategy的临床试验
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