PREDICTORS OF INAPPROPRIATE HOSPITAL DAYS IN A DEPARTMENT OF INTERNAL-MEDICINE

Background This study;aimed to identify predictors of inappropriate ho spital days in a department of internal medicine, as a basis for quali ty improvement interventions. Methods The appropriateness of 5665 hosp ital days contributed by 500 patients admitted to the Department of In ternal Medicine, Geneva University Hospitals, Switzerland, was;assesse d by means of the Appropriateness Evaluation Protocol. Predictor varia bles included patient's age and sex, manner of admission and discharge , and characteristics of hospital days (weekend, holiday, sequence). R esults Overall, 15% of hospital admissions and 28% of hospital days we re rated as inappropriate. In multivariate models, inappropriate hospi tal days were more frequent among patients whose admission was inappro priate (odds ratio [OR] = 5.3, 95% CI:3.1-8.4) and among older patient s (80-95 years: OR = 3.6, 95% Cl:1.7-7.0, versus <50 years). The likel ihood of inappropriateness also in creased with each subsequent hospit al day, culminating on the day of discharge, regardless oi the total l ength of stay. Conclusions This study identified both the admission an d the discharge processes as important sources of inappropriate hospit al use in a department of internal medicine. The oldest patients were also at high risk of remaining in the hospital inappropriately. Surpri singly, long hospital stays did not generate a higher proportion of in appropriate days than short hospital stays. This information proved us eful in developing interventions to improve the hospitalizalion proces s.