Patient Interview/readmission Chart Review Page 9
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12Was this admission related to previous admission?
Yes
No
Category of readmission unforeseen* related to problems in the previous admission:
Unforeseen and caused by new problem
Yes
Unforeseen related to problems in the previous admission
Yes
Foreseen (planned)
Yes
*Unforeseen= unexpected, unanticipated, unpredicted
Potentially preventable issues-PATIENT ISSUES: Based on the interviews conducted and chart
review; identify actions or issues that may be contributed to this readmission (choose all that
apply)
Lack of adherence to:
Medications
Yes
Therapies
Yes
Daily Weights
Yes
Diet
Yes
Did not have adequate understanding of medications on medication list
Yes
Did not accept HH referral
Yes
Did not accept HH planned visit
Yes
Did not accept referral to outpatient clinics
Yes
Accepted referral to outpatient but did not go to f/u appointment
Yes
Did not go to follow-up doctor appointment
Yes
Financial issues
Yes
Did not accept referral to Palliative Medicine
Yes
Did not accept referral to Hospice
Yes
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