Table 1 Template Indicating Study Codes and Definitions
From: A qualitative investigation of healthcare workers’ strategies in response to readmissions
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 |