eP706 - Pilot WOCN Telephone Follow up Program for New Adult Ostomates After Colorectal Surgery

Purpose/Background: Early postoperative complications after ostomy creation have been shown to occur in approximately 25% of patients. These complications can lead to Emergency Room (ER) visits and readmissions. Meeting with a Wound Ostomy Continence Nurse (WOCN) has been shown to reduce complications, but not all patients attain stoma competency before discharge due to distractions like pain and limitations in time. This pilot project aims to demonstrate that a telephone follow-up intervention program with a WOCN after discharge can reduce peristomal complications (PSCs) associated ER visits and hospital readmissions in new adult ostomates.Methods/Interventions: New Colorectal Surgery Ostomates between 2/2023 and 4/2023 were included in the study. A telephone follow up by a WOCN was conducted within one week of discharge to assess stoma output, self-efficacy, ostomy supplies, provide education, and initiate referrals. Self-efficacy was evaluated using the LIKERT scale responses to measure level of confidence with pouch changes. Follow up was conducted weekly over an 8-week period. Exclusion criteria included double ostomy, urostomy, ostomy revision, transfers, length of stay >7 days, and prior ostomy surgery within 3 years. Postintervention results were compared to a cohort of preintervention patients. A cost saving evaluation was performed using institutional average ER visit and readmission costs.Results/Outcomes: 12 eligible patients engaged in telephone follow up and were compared to a historical cohort of 127 patients. The 30-day readmission rate was 15.75% (n=20) pre-intervention and 8.33% (n=1) post-intervention. The 30-day ER visit rate was 12.6% (n=16) pre-intervention and 0% post-intervention. During phone follow-up, 16.6% (n=2) of patients had PSCs, and 58.3% (n=7) of patients reported low stoma self-efficacy. A total of 8 (66.6%) patients required a referral after phone follow up visit was performed, 2 of whom required multiple referrals. Four patients were referred to their surgeon for an earlier visit, while 4 were referred to the WOCN for leakage, PSC assessment, and pouching technique reinforcement. Three patients were referred to clinic RN to order missing ostomy supply and schedule post-op appointments and one patient was referred to case management. The cost of implementing the WOCN telephone follow up program during the study period was $1,406.88. Our institutional average ER visit cost was $1,097 and average readmission cost was $19,440. Based on the reduced ER visit and readmission rates, our pilot WOCN telephone program was associated with $17,553.32 cost savings.Conclusion/

Discussion: New ostomates have low stoma self-efficacy after surgery and frequently require reinforcement. Conducting a telephone visit within 1 week of discharge provides an opportunity to assess patients and provide education and resources. A straightforward WOCN based phone intervention program was associated with both reduced ER visits and hospital readmissions leading to institutional cost savings.