Table 3 Examples of root causes
From: Unplanned return presentations of older patients to the emergency department: a root cause analysis
Main category | Subcategory | Example |
|---|---|---|
Organisational | External | No check upon the patient by homecare personnel due to shortage of personnel. Due to the late recognition the wound was in a severe state and needed treatment at the ED instead of at the GP. |
Protocol | A switch of antibiotics due to lack of a clear protocol. The patient had no progression of complaints but had to return for the switch. | |
Management priorities | Inability to have short-term follow-up diagnostics and to make short-term appointments at the outpatient clinic. Inability to contact the GP. | |
Human | External | An inadequate assessment of the severity of complaints by family of the patient. |
Coordination | The coordination of the location where the patient has to present with his complaint. A well-known patient with anemia, in need of blood transfusions once a week, has to present at the ED instead of going directly to the ward for treatment. | |
Verification | The patient contacted the GP by phone, the GP did not visit and assessed the patient at this house but instead advised the patient to go the ED directly. | |
Intervention | A delay in diagnose and treatment a patient presenting at the ED with a painful red leg first diagnosed as an infection for which antibiotics were prescribed, returning to the ED because of persisting complaints and pain. During the return presentation it becomes clear that the complaint is not the results of an infection but of a trombo-emboli which needs a different therapy. | |
Monitoring | The GP is arranging the transfer for a patient from his house to a rehabilitation center, in the meanwhile the homecare support for this patient is insufficient. | |
Patient | Patient | Refusal of patient to contact the GP before visiting the ED. Refusal of patient to participate with a fall analysis after prior visit, returns at the ED with a second fall. |
Disease | Collapse due to lung embolism, hematuria after operation, respiratory insufficiency by known lung cancer, decompensation cordis after myocardial infarct. | |
X | Unclassifiable | Side-effects of medication, for example chemotherapy. Closure of the outpatient clinic because of a national holiday. |