APPROPRIATE USE OF PEDIATRIC HOSPITALIZAT ION - A MULTICENTRIC STUDY IN 13 ITALIAN PEDIATRIC DEPARTMENTS

PAEP (Pediatric Appropriateness Evaluation Protocol) was slightly modi fied to assess the appropriateness of 1296 admissions and 4434 days of care in 13 Pediatric Departments during the period January 1-31, 1995 . Mean appropriateness was 84.5% for admissions and 63% for days of ca re. Appropriate admissions were due more to the patient's conditions ( 60%) than to the need of medical or nursing sen,ices. On the contrary, appropriate days of care were nlte more to the need of medical/nursin g/life support services (60%). Inappropriate admissions were mainly du e to the need of diagnostic procedures (ecography, nuclear magnetic re sonance, computerized axial tomography): too long waiting lists on an outpatient basis are responsible of the physician's decision to hospit alize. The largest amount of inappropriate days of care (51.5%) were d ue to the waiting for execution or result of diagnostic tests, and a l ess amount (31%) to a <<physician's prudent behaviour>> in front of a non-complete patient's cure. We conclude that lacks in diagnostic depa rtments and health care network organization (poor connection between outpatient and inpatient services) are the first cause of inappropriat e hospital days. Family and environmental problems are rarely responsi ble of inappropriate hospital stay (7%). 50% of children were discharg ed before 48 hours from admission, and 81% of them had a real necessit y to be hospitalized. This shows that a short hospitalization is often required and necessary for the first management of an acute problem i n children.