Readmissions in neurosurgery: a qualitative inquiry.

Objective: To identify deficiencies leading to readmissions to the University of Florida Neurosurgery Service by using the Institute for Healthcare Improvement STate Action on Avoidable Rehospitalizations Readmissions diagnostic tool and to report the opinions of patients, their families, and health care providers.
Methods: A retrospective review of hospital admission and discharge data was conducted. All patients who met eligibility criteria and who were discharged from the neurosurgery service between January 1 and March 31, 2012, and readmitted within 30 days after discharge (n=74; 66 patients; 7 multiple readmissions) were included. A chart review revealed potential precipitating factors. Health care providers, patients, and family members were also interviewed. Median values and frequencies were used to summarize the data.
Results: The 30-day readmission rate on the neurosurgery service was 14%. Problems associated with wound care accounted for 24% of readmissions, neurologic conditions accounted for 50%, and other medical conditions accounted for 26%. Patients and providers agreed on the medical diagnoses resulting in readmission, but providers also often named "patient noncompliance" as a factor leading to readmission, whereas patients often thought they either were "sent home too early" or had a "general decline with no improvement."
Conclusions: Systematic patterns and common themes associated with patient readmissions were identified for a neurosurgical service. These findings are now being used to implement changes in discharge planning.
(Copyright © 2014 Elsevier Inc. All rights reserved.)