"A long case is another factor, because a long time in surgery can be a marker for technical difficulties," he says. "Probably the biggest risk for readmissions is going to be complications at the time of surgery."
Success key No. Key 2: Choose the right setting
Readmission rates also can be affected by where the surgery is performed, Morton notes. Only two of the three common bariatric procedures in the United States can safely be performed in an outpatient setting—the gastric band and, under some circumstances, the sleeve, he says.
"There's a potential for higher readmission rates in ambulatory surgery," Morton says. "There is a certain amount of patient education that takes place in an inpatient setting that may not be happening in ambulatory surgery. That's not to say that an ambulatory surgery center can't do the same level of education, but it's not routinely done."
Any risk factors identified in the patient evaluation should be considered carefully when determining whether outpatient surgery is acceptable or poses too much of a readmission risk for that patient, he says. The more risk factors a patient has, the less likely that outpatient surgery is the right choice.
Success key No. 3: Educate, educate, educate
Pilot projects at Stanford and other bariatric programs have shown that the level of patient education about bariatric surgery and postop requirements has a significant effect on readmissions. Key points to emphasize are the need to ensure that the patient stays hydrated, knows the right and wrong foods to eat, and avoids advancing the diet too quickly.
Stanford and other healthcare institutions have standardized their preop education, creating a video that provides consistent messaging. The video includes presentations from a range of disciplines, including nutrition, psychology, and pharmacy. Patients can watch it repeatedly, which Morton says is important not only for the reinforcement but also because patients may be distracted or stressed the first time they watch.
"We give that education when they are an inpatient, and give them a phone call the day after discharge to remind them and answer any questions," he says. "Part of that education process includes discussing their medications and how those may change after surgery."
Realizing that postop education and monitoring was critical to avoiding readmissions, Stanford made the postop phone call more than just a cursory "How are you doing?" Instead, Stanford budgeted nursing time for the calls and set expectations for what information was to be conveyed and collected.
Gregory A. Freeman is a contributing writer for HealthLeaders.