Factors associated with potentially avoidable admissions
| Factor | Potentially avoidable admissions, no (%)* n = 67 |
|---|---|
| Health system | |
| Government directive of 4-hour limit for admission decision-making | 28 (42) |
| Subspecialist request to admit | 22 (33) |
| Overcrowding in the ED | 13 (19) |
| Lack of available services to determine suitability of safe discharge | 10 (15) |
| Poor access to urgent outpatient investigations | 10 (15) |
| Unavailable specialist or ancillary care | 8 (11) |
| Lack of timely access to community-based resources | 4 (6) |
| Provider | |
| Diagnostic and therapeutic uncertainty | 38 (57) |
| Perceived need for short-term patient monitoring | 32 (47) |
| High number of consults during shift, admitted to increase efficiency with workload | 12 (18) |
| Resident–faculty culture (admitting to avoid overnight call to staff physician) | 4 (6) |
| Uncertainty regarding patient preference | 2 (3) |
| Patient and family | |
| Frailty (physical or cognitive) | 16 (24) |
| Health literacy: language barrier | 10 (15) |
| Socially isolated; lack of social support; unsafe to discharge without access to caregivers | 4 (6) |
| Lack of access to housing/transportation home | 1 (1) |
| Mental illness or substance use; concern re: risk of harm | 1 (1) |
Note: ED = emergency department.
↵* More than 1 factor may have been selected for each avoidable admission.