Reduction in hospital reattendance due to improved preoperative patient education following hemorrhoidectomy.

INTRODUCTION: To improve quality of healthcare, patient information must be thorough and easy to understand. This is important in day surgery where patients are seen less often by health practitioners. We looked at the impact of improving patient information in the setting of day-case hemorrhoidectomy in terms of patient satisfaction and whether medical attention was sought after the operation. METHODS: A retrospective, comparative study was performed on 60 patients undergoing day-case hemorrhoidectomy and on 60 patients undergoing the same operation with improved patient information. Comparisons were made between the groups regarding patient satisfaction scores, those seeking medical attention, the numbers of patients requesting a 6-week outpatient follow-up and the reasons for seeking medical advice. RESULTS: There was a significant improvement in the patient satisfaction scores in the second study group who received the improved information. This group sought medical attention significantly less and they felt less need for a routine follow-up. CONCLUSIONS: This study has shown that by improving the quality of patient information for day-case hemorrhoidectomy, patient satisfaction was higher and fewer patients sought medical attention, which has beneficial financial indications for the NHS Trust and improvement of healthcare for the patient.

Focused preoperative patient stoma education, prior to ileostomy formation after anterior resection, contributes to a reduction in delayed discharge within the enhanced recovery programme.

PURPOSE: Stoma formation is a well-known cause for delayed discharge following colorectal surgery. This has been addressed by the enhanced recovery programme (ERP) preoperatively through stoma counselling sessions. These aim to promote independent stoma management post-operatively, thus expediting hospital discharge. We compared the numbers of patients with prolonged hospital stay secondary to delayed independent stoma management prior to and following the introduction of an enhanced recovery programme with preoperative stoma education. METHODS: Data collection on patients undergoing anterior resection with the formation of a loop ileostomy was carried out retrospectively prior to ERP (January 2006 to August 2008) and prospectively following the introduction of ERP (September 2008 to October 2010). Comparisons were made in patients with prolonged hospital stay (defined as hospital stay of more than 5 days) secondary to stoma management. RESULTS: Two hundred forty patients underwent elective anterior resection with the formation of a loop ileostomy, 120 prior ERP and 120 post-ERP. Average length of hospital stay was 14 days before ERP introduction, with a range of 7-25 days. The mean length of stay amongst the ERP patients was 8 days (p = 0.17), ranging from 3 to 17 days. Twenty-one patients in the pre-ERP group (17.5%) experienced postponed hospital discharge due to a delay in independent stoma management, compared to one patient experiencing such a delay after the introduction of ERP (0.8%, p < 0.0001). CONCLUSIONS: Delayed discharge secondary to independent stoma management can be significantly reduced with preoperative stoma management teaching as part of an enhanced recovery programme.