Reducing Emergency Department Referrals for Dehydration Following Bariatric Surgery

Abstract

Problem: Following bariatric surgery, approximately 20-25% of post-surgical patients in the weight management clinic of a large academic medical center are referred to the emergency department (E.D.) for intensive treatment of symptoms related to dehydration. Current literature indicates that implementing dehydration prevention measures in post-bariatric surgery patients could decrease the number of these patients referred to the E.D. for treatment through additional surveillance and early intervention. Purpose: This quality improvement project aims to reduce the number of post-operative patients referred to the E.D. for treatment of dehydration through standardized screening and early identification of at-risk patients. This will translate into reduced E.D. referral rates and outcomes improvement with early identification of potential problems. Methods: Over fifteen weeks, the New Geriatric Dehydration Screening Tool (NGDST) was implemented in the outpatient bariatric surgery clinics of a large teaching hospital centrally located in a medium-sized city. Each post-operative care clinic provider completed education and training on the application of the NGDST, the recording and interpretation of results, and the new screening pathway for interventions. The NGDST was then implemented and utilized in screening post-operative patients within the first month of bariatric surgery. Results: There was one E.D. referral for dehydration during the NGDST implementation period, compared to fourteen E.D. referrals during the same time the previous year resulting in a 2% E.D. referral rate representing a significant reduction from the 20% rate before implementation. Conclusions: A standardized dehydration screening tool significantly decreased referrals to the E.D. for dehydration compared to the same period in the previous twelve months. Keywords: bariatric surgery, dehydration, post-operative care, dehydration screening tool, New Geriatric Dehydrations Screening Tool, NGDST