Background

Dietary changes and opiate usage following bariatric surgery may lead to constipation and patient discomfort. While seemingly self-limited, constipation is a common source of patient complaint and can back up over-burdened emergency department (ED) and hospitals. Here we describe a novel initiative to decrease healthcare admission with a dedicated quality improvement project.

Methods

All ED and hospital admissions are reviewed monthly by an Advanced Practice Provider (APP) Council from the ambulatory and in-patient settings. Dedicated review found constipation to be leading source of utilization. Utilizing IHI methodology (PDCA), the following quality improvement processes were employed (monthly review of all admissions, Pre-op laxative algorithm & Post-op laxative algorithm initiated, AVS summary standardize /SMART DOT phrase created, Pre-op & Post-op questionnaire updated to include question in regards to constipation, question added in discharge script phone calls- 24-48 hours, Hydration & ambulation reinforced, Teach Back reinforced with patient, and full ERAS utilization to minimize narcotic use.

Results

In the period prior to the QI project (January 1,2020-April 30,2021), there were 12 events - 2.52% from a total 477 cases. Following the implementation of the QI project from May 1, 2021-Current, only 3 events were recorded for a 1.82% rate from a current total of 165 cases resulting in a significant difference from baseline.

Conclusions

Conclusions: Utilizing IHI methodology and a process driven methodology, ED and hospital admissions fell significantly for constipation through this multi-disciplinary initiated project.