A multi-level stakeholder-centered approach to investigate unnecessary readmissions in emergency departments

Unnecessary readmissions have become a recurring problem in the Emergency Departments (ED) across the United States. While the current knowledge on the contributors to this problem is dominated by patient-level factors, an understanding of more diverse perspectives across the healthcare organization is needed. This research study provides a multi-level stakeholder-centered view of the problem of readmissions in EDs. Interviews were conducted with 12 relevant stakeholders at different levels of the hierarchy of a representative U.S. healthcare system, including senior leadership, clinical management, and front-line patient care. Thematic analysis was conducted to identify factors that contribute to unnecessary readmissions, and potential strategies to reduce readmissions. The findings revealed eleven potential factors that may contribute to unnecessary ED readmission, including culture, resources constraints, and locality-based factors, among others. Ten potential strategies to reduce readmissions were derived from the interview analysis including, centralized and accessible information, patient education, and coordination with local clinics, among others. Further, a thematic mapping was created to connect the identified factors to the potential strategies. Findings reveal a complex relationship between readmission factors and reduction strategies. Further investigation is needed to validate these findings and to integrate and implement these strategies as bundled interventions in practice.