Patients routinely receive hospital discharge instructions that are usually developed by the staff of the particular hospital from which the patient is being discharged. Consequently, there is little standardization among discharge instructions and many times, these instructions are generic in their focus (e.g. all patients who have a surgical operation receive the same instructions).
To address this gap in knowledge and practice, an 11-member expert panel was convened to identify signs and symptoms that patients should report following colorectal surgery. The panel used a standardized Delphi process to reach a national consensus, which was defined as the point when at least 70% of the experts rated a symptom as 4 or more on a 5-point Likert scale (e.g. agree or strongly agree).
The expert panel members identified 10 signs and symptoms that patients should immediately report if they occur following colorectal surgery. They include wound drainage, wound opening, wound redness or changes in the skin around the wound, no bowel movement or lack of gas/stool from an ostomy for more than 24 hours, increasing abdominal pain, vomiting, abdominal swelling, high ostomy output and/or dark urine or no urine, fever greater than 101.5°F, and not being able to take anything by mouth for more than 24 hours. Two additional symptoms that require patients to seek emergency care shortness of breath or inability to breathe and chest pain. The expert panel hopes that this list will be used in clinical practice to guide discharge instructions for patients post colorectal surgery. This process also can be used to identify specific discharge instructions following other types of surgery.
Li LT, Mills WL, Gutierrez AM, et al. A patient-centered early warning system to prevent readmission after colorectal surgery: a national consensus using the Delphi method. Journal of the American College of Surgeons; 2012; 216(2): 210-216.