Back So Soon? Part 2: Use of the 5 "Whys" Process in Unplanned Hospital Readmissions

Readmission prevention strategies are the focus of many hospitals, but despite these efforts, unplanned, all-payer hospital readmission rates are increasing. The purpose of this study was to use root cause analysis (RCA) to explore the main cause (medical, behavioral health, and/or social) for the unplanned 30-day readmissions that the Readmission Prevention Team followed up and then to use this data to change and/or refine discharge planning interventions.

The primary practice setting was the 229-bed study hospital where subjects with 30-day unplanned readmissions who were followed up by the Readmission Prevention Team were admitted. The venues that subjects were readmitted from were noted as home without services, home with home care, skilled nursing facility (SNF), acute rehab, physician office, hospice/palliative care, and refused care.

Using a descriptive, correlational, qualitative design, demographic data (age, gender, days between discharge and readmission, and the venue from which the patient was readmitted) were collected from the RCA worksheets of each subject with an unplanned hospital readmission within 30 days.

Among the 150 subjects, the main cause for readmission was medical (92%), with 19 of the subjects (13%) demonstrating multiple root causes. Women were readmitted more frequently than men, and the prominent age range was the 70s and 80s. The two main readmission venues were home with home care (54.7%) and skilled nursing facilities (23.3%).

Medical was the chief cause of readmissions in this study, with many case management interventions noted in the literature to address these issues. Behavioral health and social issues were responsible for 13% of the readmissions. These issues are more complex, and hospitals should review the interventions that they have in place and develop others that are needed to decrease these types of readmissions.Home with home care was the main venue of readmission, with return from a skilled nursing facility (SNF) being the second. Potential interventions to decrease these unplanned hospital readmissions might include developing a backup discharge plan (Option B) and developing improved communication avenues between the hospital emergency department and the SNF that might lead to the patient returning to the SNF versus being admitted.