Background:
The Institute for Healthcare Improvement recommends that any unplanned readmission within 30 days of discharge prompt a formal case review to identify systematic flaws in discharge processes. Residency programs are also being charged to engage house staff in quality improvement (QI) programs in order to improve knowledge and skills in systems‐based practice (SBP).
Purpose:
We developed a readmission case review system with medical interns on a QI rotation. The purpose of this project was twofold: (1) to understand the epidemiology of our unplanned readmissions, including estimation of pre‐ventability; and (2) to provide a quality improvement educational experience for the interns.
Description:
Beginning June 2010, all unplanned readmissions to the medicine service within 30 days of discharge were reviewed by interns during a 2‐week QI rotation. Newly readmitted patients were identified daily, and reviews were performed in real time while the patient was hospitalized. Interns used a standardized case review form based on the BOOST project's “7 P's” risk factors, which provided a framework for the analysis of each case by chart review, discussions with the discharging and re‐admitting physicians, and (when possible) patient interviews. Based on this information, interns were asked to characterize the reasons for readmission and whether the readmission was preventable. For possibly preventable cases, interns identified systems issues that contributed to the readmission and reflected on how case‐by‐case findings would change their future practice. Interns presented their findings at morbidity and mortality conferences and to our institution's BOOST committee. In the first 4 months of the rotation, interns reviewed 111 cases of readmission and considered approximately 20% to be preventable. Each case review took approximately 1.5–2 hours. Fifteen interns completed the quality improvement rotation. Overall, the rotation was well received. Interns reported that the rotation helped them understand causes of care delivery problems in the hospital and how to analyze adverse events in order to identify contributing systems causes, with Likert scores of 4.47 and 4.53 of 5, respectively. However, in the qualitative comments, interns believed that reviewing cases of nonpreventable readmissions had less educational value.
Conclusions:
Performing structured reviews of readmitted patients is a valuable educational experience for medical interns and is a practical way of engaging house staff in quality improvement activities. Based on the intern comments, prescreening readmissions to focus on possibly preventable cases may improve educational value.
Disclosures:
S. Iobst ‐ none; S. Ranji ‐ none