title: Exploring the preventable causes of unplanned readmissions using root cause analysis: Coordination of care is the weakest link.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Cross-sectional retrospective record study.
  
  
  METHODS
  An academic medical center in Amsterdam, The Netherlands.
  
  
  METHODS
  Fifty patients aged 18years and older discharged from an internal medicine department and acutely readmitted within 30days after discharge.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Our study suggests that improving human-related (coordinating) factors contributing to a readmission can potentially decrease the number of preventable readmissions.
authors.affiliation: Department of Internal Medicine, Section Acute Medicine, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: K S
authors.initials: KS
authors.lastname: Fluitman
authors.affiliation: Department of Internal Medicine, Section Acute Medicine, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: L S
authors.initials: LS
authors.lastname: van Galen
authors.affiliation: Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Merten
authors.affiliation: Department of Internal Medicine, Section Acute Medicine, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: S M
authors.initials: SM
authors.lastname: Rombach
authors.affiliation: Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Brabrand
authors.affiliation: Department of Acute Medicine, University Hospital of South Manchester, Manchester, UK.
authors.forename: T
authors.initials: T
authors.lastname: Cooksley
authors.affiliation: Department of Emergency Medicine, University Hospital Basel, Basel, Switzerland.
authors.forename: C H
authors.initials: CH
authors.lastname: Nickel
authors.affiliation: Ysbyty Gwynedd Hospital, Wales, UK.
authors.forename: C P
authors.initials: CP
authors.lastname: Subbe
authors.affiliation: Department of Internal Medicine, Section Acute Medicine, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: M H H
authors.initials: MHH
authors.lastname: Kramer
authors.affiliation: Department of Internal Medicine, Section Acute Medicine, VU University Medical Centre, Amsterdam, The Netherlands. Electronic address: p.nanayakkara@vumc.nl.
authors.forename: P W B
authors.initials: PWB
authors.lastname: Nanayakkara
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006282:Health Personnel; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D058996:Quality Improvement; D012189:Retrospective Studies; D060891:Root Cause Analysis; D013997:Time Factors
keywords: Patient readmission; Quality improvement; Root cause analysis