APPROPRIATENESS OF ADMISSION AND THE LAST 24 HOURS OF HOSPITAL-CARE IN MEDICAL WARDS IN AN EAST LONDON TEACHING GROUP HOSPITAL

Objective: To assess the rates of inappropriateness of admission and l ast day of care on adult medical wards in an east London hospital, to identify associations with any inappropriateness and to assess what se rvices need to be improved or provided if patients assessed as ''inapp ropriate'' are to be more appropriately placed in the future. Design: From the patients' medical notes, nursing notes and ward charts, a tra ined reviewer with nursing and university qualifications collected con current information about each patient's first 24 hours as an in-patie nt and about the last 24 hours of care preceding discharge, Patients w ere also interviewed before discharge and 7-10 days after discharge, a nd their health status and level of satisfaction about the discharge p rocess assessed. Setting: The three adult medical wards at the Homerto n Hospital in Hackney, east London, This hospital is within the St Bar tholomew's Hospital Teaching Hospital Group. Subjects: The case-notes of a random sample of 625 adult in-patients were reviewed. End points: Appropriateness of admission and last day of care. Main outcome measu res: The main instrument used was the Appropriateness Evaluation Proto col (AEP), This is an instrument devised to assess the appropriateness of adult patient admission to, and specific days of care in, acute ho spital beds through case-note review against a structured set of crite ria. Results: The study presented here reported that 31% of in-patient admissions to adult medical wards in an east London hospital were ina ppropriate, and also that 66% of the last days of stay were inappropri ate. Conclusions: There is clearly considerable room for improvement i n relation to cooperation between service providers in order to maximi se efficient bed use, Delays due to waiting for medications from pharm acy, and the combination of more ''inappropriate'' cases wanting help from social services after discharge with the fact that many of them w ere still in hospital because they were waiting for these services to be organized, suggest that inappropriateness could be reduced through increased efficiency or increased provision in these areas, The study reported here is unique in its inclusion of patient interview data, Co pyright (C) 1996 Elsevier Science Ltd.