Background

Elevated rates of Roux-en-Y gastric bypass (RYGB) all-cause and surgery-related interventions, identified as 'Needs Improvement' in SAR, prompted investigation of causation. One potential causative factor identified was a failure of ED physicians to consult with the bariatric (Bari) team upon arrival of the bariatric patient to the emergency department (ED), leading to avoidable readmissions, unnecessary diagnostic tests/procedures, inappropriate diet and medication management, and lost educational opportunities. We, therefore, instituted a protocol to improve ED notification of bariatric patient ED encounters.

Methods

The protocol was developed in collaboration with hospital and ED administrators to provide oversight for bariatric patient care by the Bari team and to utilize admission/encounters as an educational opportunity to improve patient adherence to bariatric guidelines. The primary goal of the protocol was 100% compliance with notification of bariatric patient ED encounters following protocol initiation and the secondary objective was reduction of all-cause and surgery-specific RYGB interventions to the goal of 'As Expected' on SAR.

Results

Over a period of 7 months, the percentage of encounters reviewed increased from 28% to 100%. By December, ED compliance with notification of the Bari physician was 92% along with an increase in Bari team patient education (40% to 70%). Following initiation of the collaborative protocol, the number of all-cause and surgery-related interventions following RYGB significantly declined to meet 'as expected' criteria on SAR.

Conclusions

A protocol that improves ED compliance for notification of the Bari team with ED bariatric patient encounter reduces the incidence and risk for postoperative intervention.