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Patient Safety and Quality Improvement

(276) Interprofessional Approach to Improving Head and Neck Discharge Instructions

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio

    Presenting Author(s)

  • Alexandria Danyluk, BA

    medical student
    University of Florida
    Gainesville, Florida, United States

    • Co-Author(s)

  • Alexandria Danyluk, BA

    medical student
    University of Florida
    Gainesville, Florida, United States

    • Presenting Author(s)

  • Janyn Quiz, MD

    Resident
    University of Florida
    Gainesville, Florida, United States

    • Senior Author(s)

  • Janyn Quiz, MD

    Resident
    University of Florida
    Gainesville, Florida, United States

    • Co-Author(s)

  • Peter Dziegielewski, MD

    Chief, Head and Neck Surgical Oncology & Microvascular Reconstructive Surgery
    University of Florida
    Gainesville, Florida, United States

Disclosure(s):
Alexandria Danyluk, BA: No relevant relationships to disclose.
Janyn Quiz, MD: No relevant relationships to disclose.
Peter Dziegielewski, MD: No relevant relationships to disclose.


Introduction: This project aims to improve outcomes for patients who underwent head and neck free flap surgery by implementing streamlined and patient-centered discharge instructions via interprofessional collaboration.

Methods: We collaborated with speech therapy, physical/occupational therapy, nursing, and dieticians to create new standardized discharge instructions for patients who have undergone head and neck flap surgery. From 323 patients who underwent free flap reconstruction between 2021-2022, two cohorts were selected: Before Intervention (n = 54) and After Intervention (n = 60), from selected timeframes in which provider teams had comparable levels of experience. Patients were excluded if they had a longer admission due to complications.

Results: Patients who received the improved discharge instructions had fewer instruction-related phone calls (5.83 vs. 8.55 per 100 phone calls) and fewer hospital readmissions or ED visits (28.3% vs. 40.7%) during the 5-week post discharge period. Among the instruction-related phone calls, decreases in those relating to medications (RR = 86%), nutrition (RR = 55%) and hygiene (RR = 66%) were observed after the new discharge instructions were implemented. Wound care phone calls increased (RR = 82%), however, there was a large decrease in bounce backs for wound care issues specifically, from 24 to 11 per 100 patients. Additionally, patients who received the new discharge instructions had a 13.7% increase in adherence to the standardized two post-op visits in the 5-week period following discharge.

Conclusions: Multidisciplinary standardized discharge instructions were associated with improved quality measures including decreases in hospital readmission, ED visit, and instruction-related phone call rates, and an increase in outpatient post-op follow up adherence for patients with head and neck flap surgeries.