System-Based Approach to Educating Internal Medicine Residents on Preventable Hospital Readmissions

Abstract

Background A literature gap exists in educating internal medicine residents about hospital readmissions and how to prevent them. Intervention The study aimed to implement a readmissions education initiative for general internal medicine inpatient resident teams in 3 general practice units at an urban, tertiary hospital. Methods Senior residents were given access to a daily list of readmissions, used a readmission assessment tool to investigate causes and to assess whether each readmission was preventable, led a monthly general practice unit team meeting to discuss each case, and presented their findings at the monthly multidisciplinary readmissions meeting for additional feedback. For program evaluation, we hypothesized that the “preventable” readmissions count tracked via the readmissions assessment tool would increase as residents became better educated on the root causes of readmissions. We also conducted a survey to assess perception of the readmissions education initiative. Results “Preventable” readmissions increased from 21% for the first 3 months of the intervention (September–November 2010) to 46% for the most recent 3 months (January–March 2011). The survey showed that 98% (41 of 42) of respondents who had attended a multidisciplinary readmissions meeting felt involved in an effort to review or improve the rate of hospital readmissions, whereas only 40% (21 of 53) of the group that never attended a session shared the same answer. Conclusions This initiative required few resources, and it appeared to help residents identify “preventable” reasons for readmissions, as well as increased their perceptions of being actively involved in reducing hospital readmissions. The intervention was not associated with a statistically significant reduction in readmissions, which may be influenced primarily by multiple factors outside residents' control.

Preventability of unplanned readmissions within 30 days of discharge. A cross-sectional, single-center study

“…In accordance with previous studies [15], all residents could verify their conclusions with a senior professional. The first month of this study was a pilot phase to evaluate the feasibility and reliability of the screening, interview and review process.…”

“…Interdepartmental, integrated care issues and medication errors were recognized by the different members of the team. Previous studies using a multidisciplinary approach are limited [15,23,26,27] and, to our knowledge, none of them specifically described the added value of this approach. The multidisciplinary meeting resulted in a modification of the final conclusion on preventability in 1 in 9 cases.…”

How do studies assess the preventability of readmissions? A systematic review with narrative synthesis

“…Several studies used an existing tool, like the STate Action on Avoidable Rehospitalizations (STAAR) initiative [14, 21, 27, 30, 34] or root cause approach [5, 18, 24, 35–37] but all others adapted an existing tool or developed their own tool based on previous publications. For the purpose of this article we focused only on the distinction between studies using an a priori preventability cause classification [13–16, 19, 21–26, 31, 35, 37–55], or not [5, 17, 18, 20, 27–30, 32, 33, 36, 56–59], see Table 2 . As an example of an a priori cause classification, Clarke et al reported, Unavoidable causes: chronic or relapsing disorder; unavoidable complication, readmission for social or psychological reason, reasons probably beyond control of hospital services, completely different diagnosis from previous admission.…”

Machine learning modeling for predicting hospital readmission following lumbar laminectomy

“…3,40 Driven by a consumer push toward a higher quality of care and programs such as the HRRP, there has been increasing interest and research in reducing readmissions, especially those identified as preventable. 4,19,27 By recent estimates, preventable readmissions make up as much as 20% of these cases and cost up to $17 billion annually. 37 There are also ongoing efforts to better understand and identify the factors that lead to readmission, which can lead to the development of more effective interventions.…”