title: Using Human Factors and Systems Engineering to Evaluate Readmission after Complex Surgery.
abstract: BACKGROUND
  Our objective was to use a human factors and systems engineering approach to understand contributors to surgical readmissions from a patient and provider perspective. Previous studies on readmission have neglected the patient perspective. To address this gap and to better inform intervention design, we evaluated how transitions of care relate to and influence readmission from the patient and clinician perspective using the Systems Engineering Initiative for Patient Safety (SEIPS) model.
  
  
  METHODS
  Patients readmitted within 30 days of discharge after complex abdominal surgery were interviewed. A focus group of inpatient clinician providers was conducted. Questions were guided by the SEIPS framework and content was analyzed. Data were collected concurrently from the medical record for a mixed-methods approach.
  
  
  RESULTS
  Readmission occurred a median of 8 days (range 1 to 25 days) after discharge. All patients had follow-up scheduled with their surgeon, but readmission occurred before this in 72% of patients. Primary readmission diagnoses included infection, gastrointestinal complications, and dehydration. Patients (n = 18) and clinician providers (n = 6) identified a number of factors during the transition of care that may have contributed to readmission, including poor patient and caregiver understanding; inadequate discharge preparation for home care; insufficient educational process and materials, negatively affected by electronic health record design; and inadequate care team communication.
  
  
  CONCLUSIONS
  This is the first study to use a human factors and systems engineering approach to evaluate the impact of the quality of the transition of care and its influence on readmission from the patient and clinician perspective. Important targets for future interventions include enhancing the discharge process, improving education materials, and increasing care team coordination, with the overarching theme that improved patient and caregiver understanding and engagement are essential to decrease readmission and postdischarge health care use.
authors.affiliation: Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI; William S Middleton Memorial Veterans Hospital, Madison, WI.
authors.forename: Alexandra W
authors.initials: AW
authors.lastname: Acher
authors.affiliation: Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Tamara J
authors.initials: TJ
authors.lastname: LeCaire
authors.affiliation: Center for Quality and Productivity Improvement, Madison, WI.
authors.forename: Ann Schoofs
authors.initials: AS
authors.lastname: Hundt
authors.affiliation: Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI; Center for Quality and Productivity Improvement, Madison, WI; Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin, Madison, WI.
authors.forename: Caprice C
authors.initials: CC
authors.lastname: Greenberg
authors.affiliation: Center for Quality and Productivity Improvement, Madison, WI; Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin, Madison, WI.
authors.forename: Pascale
authors.initials: P
authors.lastname: Carayon
authors.affiliation: Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI; William S Middleton Memorial Veterans Hospital, Madison, WI.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Kind
authors.affiliation: Wisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI; William S Middleton Memorial Veterans Hospital, Madison, WI. Electronic address: webers@surgery.wisc.edu.
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Weber
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care / Q000458:organization & administration; D013505:Digestive System Surgical Procedures; D057286:Electronic Health Records / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000639:trends; D010359:Patient Readmission / Q000639:trends*; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult