Using Human Factors and Systems Engineering to Evaluate Readmission after Complex Surgery.

Area of Science:

• Human Factors Engineering
• Systems Engineering
• Patient Safety

Background:

• Previous surgical readmission studies often overlook the patient perspective.
• Understanding patient and provider experiences is crucial for effective intervention design.

Purpose of the Study:

• To investigate surgical readmission contributors using a human factors and systems engineering approach.
• To evaluate the patient and clinician perspectives on care transitions and their impact on readmission.

Main Methods:

• Mixed-methods approach combining patient interviews (n=18) and clinician focus groups (n=6).
• Utilized the Systems Engineering Initiative for Patient Safety (SEIPS) framework.
• Concurrent data collection from medical records.

Main Results:

• Readmissions occurred a median of 8 days post-discharge, often before scheduled follow-up.
• Key contributing factors identified: poor patient/caregiver understanding, inadequate discharge preparation, insufficient education, EHR design issues, and poor team communication.
• Common readmission diagnoses included infection, GI complications, and dehydration.

Conclusions:

• This study is the first to apply human factors and systems engineering to analyze care transition quality and readmission from patient/clinician viewpoints.
• Interventions should focus on enhancing discharge processes, educational materials, and care team coordination.
• Improved patient and caregiver understanding and engagement are vital for reducing readmissions.