Table 3.
Factors Identified as Contributing to Readmissions Rated as Avoidable by Hospital Root-Cause Analysis (N = 42)
| Domains and Factors Contributing to Readmissions* | Frequency (Percent) Domain | Frequency (Percent) Factor |
|---|---|---|
| Monitoring and Managing Symptoms after Discharge | 13 (31.0) | |
| Inappropriate choice of discharge location (e.g. SNF vs. home) | 1 (2.4) | |
| Lack of disease monitoring (e.g. following daily weights, etc...) | 3 (7.1) | |
| Discharged without needed procedure | 1 (2.4) | |
| Lack of clear plan at discharge for chronic medical problem | 10 (23.8) | |
| Diagnostic or Therapeutic Problems | 21 (50.0) | |
| Missed diagnosis during the index admission | 7 (16.7) | |
| Inadequate treatment of medical conditions during the admission | 16 (38.1) | |
| Inadequate treatment of pain during index admission | 0 (0.0) | |
| Inadequate treatment of medical conditions at the SNF | 4 (9.5) | |
| Inadequate treatment of pain at the SNF facility | 1 (2.4) | |
| Decision-Making Concerning Readmission | 14 (33.3) | |
| Inadequate effort to manage the readmitting problem at the SNF | 7 (16.7) | |
| Patient inappropriately sent from SNF to Emergency Department | 2 (4.8) | |
| ED inappropriately decided to admit patient | 1 (2.4) | |
| Patient discharged too soon from index hospitalization | 6 (14.3) | |
| Medication Problem or Adverse Drug Event | 12 (28.6) | |
| Errors in taking the preadmission medication history | 0 (0.0) | |
| Errors in discharge orders | 0 (0.0) | |
| Discrepancy between discharge summary and/or transfer orders | 0 (0.0) | |
| Drug-drug or drug-disease interactions | 5 (11.9) | |
| Inadequate monitoring for side effects or non-adherence | 10 (23.8) | |
| Inadequate steps to ensure medications available at the SNF | 0 (0.0) | |
| End of Life/Advanced Care Planning | 9 (21.4) | |
| Patient nearing end of life but still wants full treatment measures | 6 (14.3) | |
| Patient nearing end of life but refuses to discuss | 1 (2.4) | |
| SNF unable to manage symptoms in hospice patient | 0 (0.0) | |
| End-stage illness but palliative care not consulted during index hospitalization | 4 (9.5) | |
| End-stage illness but palliative care not consulted while at SNF | 2 (4.8) | |
| Patient with end-stage illness and goals of care not documented | 2 (4.8) | |
| Continuity of Care | 3 (7.1) | |
| Team did not relay important information to accepting physician | 2 (4.8) | |
| Follow-up appointments were not scheduled prior to discharge | 0 (0.0) | |
| Follow-up appointments were not sufficiently soon after discharge | 0 (0.0) | |
| Hospital test results were not followed up on appropriately | 1 (2.4) |
SNF – Skilled Nursing Facility
*
More than one domain and more than one factor per domain could be identified for a potentially avoidable readmission