September 11, 2025Open Access

Quality Analysis of Unplanned Readmissions Using Fishbone Diagram and Pareto Chart in a Chinese Tertiary Hospital

WHWen HuNational University of Singapore LMLi MaKunming University of Science and Technology SXShan XiongYangtze University

Key Points

The study found a 0.38% unplanned readmission rate across 341 patients, with surgical complications being the primary cause in surgical cases.
Surgical patients had a significant readmission rate of 75.79% due to complications like infections and hemorrhage.
Using a fishbone diagram and Pareto chart, the analysis highlighted key contributors to readmissions for targeted interventions.
The findings provide valuable insights for healthcare institutions aiming to enhance operational efficiency and reduce readmission rates.

Abstract

Purpose: Existing research on unplanned readmissions has primarily focused on department- or disease-specific analyses, yet it lacks a systematic hospital management perspective. This study employs quality improvement tools to analyze causes of unplanned readmissions, identify key drivers, and lay the groundwork for interventions that reduce readmission rates, alleviate patient burdens, and optimize healthcare resource utilization. Patients and Methods: This retrospective study included 341 patients who were readmitted within 31 days due to the same or related diseases. These patients were identified at a public tertiary Grade A general hospital in Chengdu between January 1, 2023, and December 31, 2024. Fishbone diagram was used to analyze the root causes of unplanned readmissions, while Pareto chart was employed to determine the distribution of the primary causes. Data were sourced from the hospital's information management system. Results: The overall unplanned readmission rate was 0.38%. In surgical patients, unplanned readmissions were predominantly attributed to surgical complications (75.79%), which primarily included surgical site infections, respiratory infections, postoperative hemorrhage or hematoma, thromboembolic events, and impaired wound healing. Preventing the above-mentioned surgical complications is a key measure to reduce readmissions among surgical patients. For non-surgical patients, disease exacerbation constituted the primary cause of unplanned readmissions (72.19%), with pancreatitis, chronic obstructive pulmonary disease, cardiac arrhythmia, and fungal pneumonia identified as high-risk diseases leading to readmissions. Strengthening the management of these high-risk diseases is crucial for preventing readmissions among non-surgical patients. Conclusion: Employing integrated fishbone diagram and Pareto chart analyses, this study systematically deciphered the root causes and dominant contributors to unplanned readmissions. These findings enabled the formulation of targeted evidence-based management strategies. This study provides novel insights and methodologies for hospital management practices, serving as a valuable reference for other healthcare institutions seeking to reduce unplanned readmission rates and enhance operational efficiency. Keywords: hospital readmission, quality improvement tools, health policy, management strategies

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