Admission estimation and inappropriate stays in a district hospital

An inappropriate hospital use, defined as hospital utilization that could h ave been occurred at a lower attending level or in less time, increases cos ts, creates inefficient management and influences on attending quality. The objective of this work was to evaluate the appropriateness and inapprop riateness of hospital admissions and stays in a district hospital for acute patients as well as causes of such inappropriateness. Material and methods. Retrospective, descriptive study based on the review of clinical records of patients who required hospital admission. A sample o f 378 patients representative of hospitalization for a 18-month period was selected. As measurement instrument the AEP (Appropriateness Evaluation Pro tocol) was used. This simple method has proved to be of high validity and r eliability for the identification of inappropriate hospital use. Results. The percentage of inappropriate hospital admissions detected was 1 3.8%, whereas the inappropriateness of hospital stays was 33.9%. As for cli nical departments, the higher percentage of inappropriateness corresponded to the Traumatology Department (43%). The causes accounting for the inappro priateness of admissions related to the <<necessity of admission>>; but at a lower level, <<diagnostic tests and/or therapy can be made on an outpatie nt basis>> and <<premature admission>>. As for hospital stays, the most com mon causes were <<not rapid discharge>> <<diagnostic tests pending, and/or <<any diagnostic and/or therapeutic procedure can be performed on an outpat ient basis>>. Conclusion. The inappropriateness degree of hospital admissions and stays i s similar to that observed in other more complex hospitals in our country. The causes underlying this phenomenon are dependent upon physician's deciss ions and social and public health conditions of the Area.