Use root-cause analysis to prevent avoidable admissions

Hospital lobby
Apply root-cause analysis to admissions, one expert suggests. (Getty/monkeybusinessimages)

Providers often apply root-cause analysis when examining medical errors or adverse outcomes, but hospitals could apply the same approach to determine which admissions may be preventable.

That's the experience of Mark R. Depman, M.D., an emergency physician at Central Vermont Medical Center, who wrote in a blog post for NEJM Catalyst that having a "toolbox" of root causes can prevent unnecessary healthcare use. For example, causes for hospitalization include social determinants of health, communication and patient and family engagement. 

Root-cause analysis requires organizations to: 

  1. Define the issue.
  2. Gather data and information.
  3. Flag potential factors that could cause the problem.
  4. Use those factors to identify root causes.
  5. Use that analysis to drive solutions.

RELATED: ACHE 2017—4 solutions to prevent medical errors 

Depman said his emergency department has begun to implement this approach by embedding some of the analysis within electronic health records. He said it could be expanded to other applications within the state's accountable care organization, OneCare Vermont

Another nontraditional application for root-cause analysis may be in improving the patient experience, as FierceHealthcare previously reported. That "design thinking" would allow providers to drill down into individualized factors that impact their satisfaction. 

This approach has been adopted by a number of big-name hospitals, like Mayo Clinic, that have used root-cause analysis to create a great sense of community among mothers on its neonatal unit.