K S Fluitman1, L S van Galen1, H Merten2, S M Rombach1, M Brabrand3, T Cooksley4, C H Nickel5, C P Subbe6, M H H Kramer1, P W B Nanayakkara7. 1. Department of Internal Medicine, Section Acute Medicine, VU University Medical Centre, Amsterdam, The Netherlands. 2. Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands. 3. Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark. 4. Department of Acute Medicine, University Hospital of South Manchester, Manchester, UK. 5. Department of Emergency Medicine, University Hospital Basel, Basel, Switzerland. 6. Ysbyty Gwynedd Hospital, Wales, UK. 7. Department of Internal Medicine, Section Acute Medicine, VU University Medical Centre, Amsterdam, The Netherlands. Electronic address: p.nanayakkara@vumc.nl.
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.
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.
Authors: Louise S van Galen; Patricia W Struik; Babiche E J M Driesen; Hanneke Merten; Jeroen Ludikhuize; Johannes I van der Spoel; Mark H H Kramer; Prabath W B Nanayakkara Journal: PLoS One Date: 2016-08-18 Impact factor: 3.240
Authors: Babiche E J M Driesen; Bauke H G van Riet; Lisa Verkerk; H Jaap Bonjer; Hanneke Merten; Prabath W B Nanayakkara Journal: PLoS One Date: 2018-09-14 Impact factor: 3.240
Authors: Bo Schouten; Babiche E J M Driesen; Hanneke Merten; Brigitte H C M Burger; Mariëlle G Hartjes; Prabath W B Nanayakkara; Cordula Wagner Journal: Eur Geriatr Med Date: 2021-11-10 Impact factor: 3.269
Authors: Babiche E J M Driesen; Mees Baartmans; Hanneke Merten; René Otten; Camilla Walker; Prabath W B Nanayakkara; Cordula Wagner Journal: J Patient Saf Date: 2021-10-13 Impact factor: 2.243
Authors: Babiche E J M Driesen; Hanneke Merten; Cordula Wagner; H Jaap Bonjer; Prabath W B Nanayakkara Journal: BMC Geriatr Date: 2020-09-22 Impact factor: 3.921