"They're not doing it here and there, between things," Morton explains. "They have dedicated, focused time for doing this because we feel it is that important."
Joanne Prentice, RN, BSN
Stanford also sends a letter to the patient's primary care physician after surgery, discussing the patient's postop plan. Morton's team at Stanford found that dietary compliance could be improved, so in addition to pre- and postop education, now the patient also meets with a nutritionist at the two-week follow-up visit."One year we had nine readmissions related to diet, and following the implementation of the nutritionist visit it went to zero," he says. "It had real impact for our practice."
Success key No. 4: Engage pharmacists more
Research has shown that improved coordination with pharmacists—both preop and postop—will lower readmission rates in bariatric surgery, Morton says. About 90% of bariatric procedures in the United States are performed in hospitals accredited through the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program from the American College of Surgeons and the ASMBS, and a hallmark of that program is multidisciplinary care that can include psychologists, nutritionists, and pharmacists.
"Medication reconciliation is particularly important for the bariatric patient because so many of them come in with multiple medical problems and multiple medications," Morton says. "The nice thing is that after surgery they're able to discontinue a lot of those medications, but it has to be done in a controlled, systematic way. That's where the pharmacist can really help out."
If the medications are not tapered properly, even a patient who won't need them after surgery can suffer an artificial drop in blood pressure or sugar levels to the point that they require hospitalization, he explains.
At MetroWest Medical Center, which comprises two hospitals and a network of supplementary service centers throughout Boston's western suburbs, when a new bariatric surgery director joined MetroWest Medical Center in Natick, Massachusetts, in 2014, the hospital used that opportunity to improve the bariatric program, notes that program's coordinator, Joanne Prentice, RN, BSN, CBN, CAPA. She met with the bariatric surgery head and discussed the importance of managing medications for comorbidities and pain.
Gregory A. Freeman is a contributing writer for HealthLeaders.