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Table 3 Final cause classification framework

From: Towards a patient journey perspective on causes of unplanned readmissions using a classification framework: results of a systematic review with narrative synthesis

Root cause

Definition

Includes

References

Technical

Defect materials, poor design of material or inaccessible material.

  

Organization – integrated care

Failures at integrated care level such as coordination and communication problems.

Coordination; Admissions for tests, procedures, or treatments that could have been performed in the previous admission; quality management (assurance and control); Responsibilities; Better use of community services, inappropriate discharge setting or appropriate discharge setting not available, care could have been provided in; primary care setting; Problems with healthcare transitions; social readmission; Suboptimal primary care case management, lack of home health/home physical therapy visit, earlier PCP follow-up necessary

[13, 48, 51, 53, 55, 57,58,59,60,61, 64, 65, 67, 72, 74, 79, 80, 82]

Organization - department level care

Failures related to inadequate organization of care for a single patient. These failures may be related to clinical processes such as diagnostics, medication, surgical procedure, surgical complications.

Surgical and non-surgical, disease-specific complications, general complications (nosocomial infection, wound complication, dehydratation, bleeding). Suboptimal drug treatment, error in drug prescription, overdosing, suboptimal medication reconciliation. Proper diagnostics not performed or not timely performed. Inadequate pain control, closer management/monitoring of comorbid disease, delay in palliative care consultation. Lack of discharge planning, early discharge. Patient education. Timely outpatient clinic visit scheduled

[3, 13, 14, 46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86]

Human - care provider

Failures resulting from shortcomings in skills and knowledge of the care provider.

Decision to admit patient, disregarding diagnostic results or concerns from collegeaues, wishful thinking, lack of experience to make a proper decision. Inadequate (clinical) skills and knowledge; or lack of experience. Patient not sufficiently monitored by care provider. Neglegence, fault

[2, 67, 68, 72, 74, 84, 86]

Human - informal caregiver

Inadequate support from informal caregiver.

Inadequate social support, wishful thinking

[13, 71, 77, 84,85,86]

Patient - selfmanagement

Incorrect behavior of the patient that may include incompliance, abuse of medication, non-adherence.)

Not showing up for follow-up care, non-compliance with medication or diet; substance abuse; patient coping, wishful thinking, lack of knowledge, patient preference (leaving against medical advice)

[13, 14, 47, 48, 51, 53,54,55, 58, 59, 61, 64, 67, 68, 71, 74, 75, 77, 79, 81, 82]

Patient - disease

Unexpected complications related to the patient’s condition (disease progression, comorbidity, severity of illness).

Unavoidable complication; unavoidable disease progression; chronic or relapsing disorder.

[3, 13, 48,49,50, 53, 58, 59, 61, 64, 66, 67, 70, 72, 79,80,81,82, 86]

Unclassifiable

Causes which cannot be allocated to one of the other themes because the cause has an ambiguous meaning

 

[13, 14, 47, 59, 65, 69, 71, 74, 75, 78, 82, 85]