A discharge protocol initiative to decrease hospital readmission following amputaton in adults with type 2 diabetes

Introduction: In the United States, lower limb amputations are more common in patients, than in those without diabetes, and can result in infections and unplanned hospital readmissions, that cost the U.S. billions of dollars annually. However, very few hospitals focus on amputation discharge education to prevent such readmissions. The purpose of this quality improvement project is to improve the quality of diabetic amputee discharge education by implementing a Diabetes-Amputation Protocol, with the intent of reducing infection related hospital readmissions. Methods: A Quality Improvement (QI) project conducted in an acute care, nonprofit hospital. A one group, pre-and-post design was used to conduct this project. Inclusion criteria: Participants >21 years of age, with T2DM, with initial amputation received the Diabetes-Amputation Protocol. Paired sample t-tests were used to compare patient knowledge, pre-and-post education. Descriptive statistics were used to calculate monthly percentages of patients who were readmitted and received the protocol. Results: The total number of participants was 30, with a mean age of 59.7 years. Findings from the DWCK questionnaire scores showed a statistically significant positive change from pre-to-post knowledge scores, with t(29) and p <0.01. The readmission rate decreased significantly from 20% to 7%, and 100% of participants received the Diabetes-Amputation Protocol. Conclusion: Improved the discharge material and individualized discharge information based on patient needs can improve patient knowledge, increase independent self-care and reduce hospital readmissions.