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

Fluitman, Kristina S.; Galen, Louise Sandra van; Merten, Hanneke; Rombach, Saskia M.; Brabrand, Mikkel; Cooksley, Tim; Nickel, Christian H.; Subbé, Chris; Kramer, Mark H. H.; Nanayakkara, Prabath W.B.

doi:10.1016/j.ejim.2015.12.021

Cited by 36 publications

(53 citation statements)

References 23 publications

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“…The classification of the root causes according to the ECM is displayed in Table 1 [ 17 , 18 , 24 ]. In this study, the ECM model was extended with disease related factors following the recommendations of Fluitman et al [ 25 ]. Three examples of root causal trees that were identified in this study are displayed in Fig 1 .…”

Section: Methodsmentioning

confidence: 99%

Long length of stay at the emergency department is mostly caused by organisational factors outside the influence of the emergency department: A root cause analysis

et al. 2018

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BackgroundEmergency department (ED) crowding is common and associated with increased costs and negative patient outcomes. The aim of this study was to conduct an in-depth analysis to identify the root causes of an ED length of stay (ED-LOS) of more than six hours.MethodsAn observational retrospective record review study was conducted to analyse the causes for ED-LOS of more than six hours during a one-week period in an academic hospital in the Netherlands. Basic administrative data were collected for all visiting patients. A root cause analysis was conducted using the PRISMA-method for patients with an ED-LOS > 6 hours, excluding children and critical care room presentations.Results568 patients visited the ED during the selected week (January 2017). Eighty-four patients (15%) had an ED-LOS > 6 hours and a PRISMA-analysis was performed in 74 (88%) of these patients. 269 root causes were identified, 216 (76%) of which were organisational and 53 (22%) patient or disease related. 207 (94%) of the organisational factors were outside the influence of the ED. Descriptive statistics showed a mean number of 2,5 consultations, 59% hospital admissions or transfers and a mean age of 57 years in the ED-LOS > 6 hours group. For the total group, there was a mean number of 1,9 consultations, 29% hospital admissions or transfers and a mean age of 43 years.ConclusionsThis study showed that the root causes for an increased ED-LOS were mostly organisational and beyond the control of the ED. These results confirm that interventions addressing the complete acute care chain are needed in order to reduce ED-LOS and crowding in ED’s.

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Section: Methodsmentioning

confidence: 99%

Long length of stay at the emergency department is mostly caused by organisational factors outside the influence of the emergency department: A root cause analysis

et al. 2018

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“…We decided to include the first 50 consecutive patient records of 2015 meeting the inclusion criteria to explore the causes of unplanned ICU-admissions, since previous studies have shown that around 50 PRISMA-analyses are credible and provide a well-founded causal-profile [ 16 , 19 ]. The following criteria were used for inclusion: all patients on general wards aged 18 years and older who were admitted to the ICU unplanned according to the NICE criteria (“an admission that could not have been deferred without risk for at least 12 hours”) [ 6 ].…”

Section: Methodsmentioning

confidence: 99%

“…Table 1 shows the classification of the root causes according to the Eindhoven Classification Model [ 28 ]. Since previous studies have shown that progression of disease is a valuable addition to this model applied in medical settings, this was added to the root causes for the current study [ 16 ].…”

Section: Methodsmentioning

confidence: 99%

“…The main goal of the PRISMA method is to build a database of incidents and process deviations by creating causal trees, from which conclusions may be drawn to suggest optimal countermeasures. This in-depth analysis method has been accepted by the World Alliance for Patient Safety of the World Health Organisation and has shown to provide effective starting points for improvement in quality of care [ 16 – 19 ].…”

Section: Introductionmentioning

confidence: 99%

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Delayed Recognition of Deterioration of Patients in General Wards Is Mostly Caused by Human Related Monitoring Failures: A Root Cause Analysis of Unplanned ICU Admissions

et al. 2016

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BackgroundAn unplanned ICU admission of an inpatient is a serious adverse event (SAE). So far, no in depth-study has been performed to systematically analyse the root causes of unplanned ICU-admissions. The primary aim of this study was to identify the healthcare worker-, organisational-, technical,- disease- and patient- related causes that contribute to acute unplanned ICU admissions from general wards using a Root-Cause Analysis Tool called PRISMA-medical. Although a Track and Trigger System (MEWS) was introduced in our hospital a few years ago, it was implemented without a clear protocol. Therefore, the secondary aim was to assess the adherence to a Track and Trigger system to identify deterioration on general hospital wards in patients eventually transferred to the ICU.MethodsRetrospective observational study in 49 consecutive adult patients acutely admitted to the Intensive Care Unit from a general nursing ward. 1. PRISMA-analysis on root causes of unplanned ICU admissions 2. Assessment of protocol adherence to the early warning score system.ResultsOut of 49 cases, 156 root causes were identified. The most frequent root causes were healthcare worker related (46%), which were mainly failures in monitoring the patient. They were followed by disease-related (45%), patient-related causes (7, 5%), and organisational root causes (3%). In only 40% of the patients vital parameters were monitored as was instructed by the doctor. 477 vital parameter sets were found in the 48 hours before ICU admission, in only 1% a correct MEWS was explicitly documented in the record.ConclusionsThis in-depth analysis demonstrates that almost half of the unplanned ICU admissions from the general ward had healthcare worker related root causes, mostly due to monitoring failures in clinically deteriorating patients. In order to reduce unplanned ICU admissions, improving the monitoring of patients is therefore warranted.

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“…Another problem with these risk models is that they do not measure preventability. A recent study demonstrated that causes of potentially preventable readmissions are mostly human-related coordination and communication failures 24. A few studies have been performed investigating opinions of patients and healthcare workers on the preventability of readmissions and discharge planning 25 26.…”

Section: Introductionmentioning

confidence: 99%

Patients’ and providers’ perceptions of the preventability of hospital readmission: a prospective, observational study in four European countries

Galen

Brabrand

Cooksley³

et al. 2017

BMJ Qual Saf

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There is no consensus between readmitted patients, their carers and treating professionals about predictability and preventability of readmissions, nor associated risk factors. A readmitted patient reporting not feeling ready for discharge at index admission was strongly associated with preventability/predictability. Therefore, healthcare workers should question patients' readiness to go home timely before discharge.

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

Cited by 36 publications

References 23 publications

Long length of stay at the emergency department is mostly caused by organisational factors outside the influence of the emergency department: A root cause analysis

Long length of stay at the emergency department is mostly caused by organisational factors outside the influence of the emergency department: A root cause analysis

Delayed Recognition of Deterioration of Patients in General Wards Is Mostly Caused by Human Related Monitoring Failures: A Root Cause Analysis of Unplanned ICU Admissions

Patients’ and providers’ perceptions of the preventability of hospital readmission: a prospective, observational study in four European countries

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