Background
Methods
Aim
Design
Settings
Participants
Informed consent
Interviews
Coding template development
Code Category | Definition |
---|---|
Causes of readmissions | |
Patient/Clinical Condition | |
Deteriorating Health (unpreventable) | Readmission due to worsening health; not necessarily preventable |
Non-compliance with treatment | Readmission due to failure to follow instructions regarding medications, diet, etc. |
Individual Characteristics | Readmission due to preference for care at hospital |
Care | |
Complications with Medication | Patient readmitted due to adverse reactions with prescribed medicine (from last admission). |
Issues with Diagnosis | Patient readmitted due to missed or misdiagnosis or care during previous visit |
Discharge Premature | Patient was discharged from care too early (sometimes due to prioritization needs in ICU) |
Issues with Handoff to Primary Care Provider | Failure to contact/alert primary care provider about patient condition |
Issues with Follow-up by Primary Care Provider | Follow up by primary care provider(s) not adequate |
Education/Knowledge | |
Patient not Educated Sufficiently | Patient readmitted due to inadequate education regarding self care after discharge |
Socio-Economic Status | |
Patient Lacking Access To Medication | Patient unable to obtain medications that would have prevented readmission |
Patient Lacking Outside Social Support | Patient unable to obtain outside support, e.g., from friends or family |
Perception of differences between readmissions and admissions | |
More Knowledge/ Access to More Information | For readmissions the provider has access and an understanding of the previous medical history (i.e. why patient was previously admitted). |
Shift in Information Management | Staff may not be as concerned about seeking care information because they know why the patient was readmitted (opposite of Degree of Assessment below). |
Shift in Degree of Assessment | More conservative approach in assessing a readmitted patient, i.e., tendency to be more cautious in treatment. |
Shift in Goals | Shift in focus to getting the patient stable enough to go home |
Shift in Communication Needs | Perception of reduced need for comprehensive communication because initial communication among healthcare workers was established during original admission. |
Shift in Need to Ask Protocol Admission Questions | Perception of reduced need to ask protocol admission questions; the responses are already on record. |
Shift in Lab Work | Perception of reduced need for lab work; results from previous admission are available. |
Waiving of Educational Requirements | The need to educate the patient is reduced; some education has already been provided. |
Stigma Associated with Readmissions | A sense of disappointment by healthcare workers that they did not succeed in healing the patient; |
Treating readmissions as new admissions | Considering every readmission as a new admission |
Strategies for preventing future readmissions | |
Educate the Patient | Future readmissions can be prevented by sufficient patient pre-discharge education regarding post discharge self-care |
Follow Up with Patient After Discharge | Future readmissions can be prevented by calling the patients or scheduling patient visits after they are discharged |
Improve Overall Care | Future readmissions can be prevented by improving care plan in hospital and overall care at home. |
Steps taken during readmission process | |
Identify Reason for Readmission | Look at/focus on why patient Is being readmitted, e.g. whether the same or new condition led to readmission |
PSN (Patient Safety Net) Form | Fill out a PSN form indicating the reason for readmission |
Insurance/Billing Steps or Considerations | Examine billing and insurance steps involved in readmissions to identify any concerns |
Logging Documentation for Readmissions | Use the Electronic Medical Record (EMR) software for tasks such as patient data entry into the admission system for recording the readmission in the documentation system |
Review Previous Care Records | Review information from the patient’s previous visit to the hospital |
Team Communication | Communication among healthcare workers (e.g., nurses and doctors) about the readmitted patient |
Obtain Feedback from Patient | Communicate with patient to obtain his/her perspective on the reason for readmission |
Communicate with Primary Care Physician | Communicate with the primary care physician of the patient for his/her perspective on the reason for readmission |
Improve Support System | Provide better support for post discharge care |
Reconcile Medications | Recognize that the type or dosage of medication may need adjustment |
Conceptual networks among codes
Results
Theme 1: Shifts in clinical assessment
“I think that always makes you reassess the patient a little closer and be more cautious about sending him out again.”
“Sometimes I think the patients are let go before they are ready.”Maybe sometimes the patients are discharged earlier than they should have been, for example if the patient wants to go or things are not completed, they get readmitted again.“Or was there something that we missed, frankly…we didn’t get the right diagnosis the first time.”
“Sending the patient out, it may have an impact because of the fact that…the criteria may change a little bit…We now realize that the patient came back once already. So we try to intervene and make sure that this patient is optimized much more than we would do for any other patient, just because…that patient would end up coming [back]. We don’t want the patient to come back again… I think we are more cautious about sending them out again.”
Theme 2: Shifts in use and management of information
“Because the patient is familiar to us, definitely…we will have a different viewpoint of a patient who is newly admitted because we know the patient well and we will continue the care that we gave.”“You have past medical history and all that [already] in the records, and what was just recently done to the patient.”
“The process might be a little easier in terms of you know, not having to go back in the charts in a very detailed way.”“And so I think it makes the communication…flow better when we have documented correctly what we have already done. And that way we don't have to…redo everything. We just kind of start at where it was left off when the patient left here.”“So when you have a readmission, I think the only thing that changes, that makes it different, is if the patient is coming back with very similar to what they were discharged with, so then you have like part of their past medical history, and all that on the electronic records.”
Theme 3: Shifts in communication patterns
“did we fail to handoff to their primary care provider and when they came back, they saw some laboratory abnormality and thought that the patient need to be readmitted, when they are [admitted]….And we try to assess that and then detail our education towards that problem right. And so, be it more patient education, be it better handoff from physician to physician……we try to target those things.”
“…and then report may not be as extensive just because the unit may know the patients already…so it’s a little bit easier, they can just tell you the changes that have occurred in the last 12, 24, 48 hours.”