Exploring the preventable causes of unplanned readmissions using root cause analysis: Coordination of care is the weakest link

Abstract

Importance: Unplanned readmissions within 30days are a common phenomenon in everyday practice and lead to increasing costs. Although many studies aiming to analyze the probable causes leading to unplanned readmissions have been performed, an in depth-study analyzing the human (healthcare worker)-, organizational-, technical-, disease- and patient-related causes leading to readmission is still missing.

Objective: The primary objective of this study was to identify human-, organizational-, technical-, disease- and patient-related causes which contribute to acute readmission within 30days after discharge using a Root-Cause Analysis Tool called PRISMA-medical. The secondary objective was to evaluate how many of these readmissions were deemed potentially preventable, and to assess which factors contributed to these preventable readmissions in comparison to non-preventable readmissions.

Design: Cross-sectional retrospective record study.

Setting: An academic medical center in Amsterdam, The Netherlands.

Participants: Fifty patients aged 18years and older discharged from an internal medicine department and acutely readmitted within 30days after discharge.

Main outcome measures: Root causes of preventable and unpreventable readmissions.

Results: Most root causes for readmission were disease-related (46%), followed by human (healthcare worker)- (33%) and patient- (15%) related root causes. Half of the readmissions studied were considered to be potentially preventable. Preventable readmissions predominantly had human-related (coordination) failures.

Conclusion and relevance: Our study suggests that improving human-related (coordinating) factors contributing to a readmission can potentially decrease the number of preventable readmissions.

Keywords: Patient readmission; Quality improvement; Root cause analysis.