Appropriateness of pediatric admissions to a tertiary care facility in Israel

Background: Appropriateness of hospital admission has both clinical and eco nomic relevance, especially in light of the growing pressure for increased efficiency of health services utilization. In Israel, the number of referra ls and use of the emergency room continue to rise along with an increase in hospital admissions and the number of inappropriate admissions. Using eval uation protocols, such as the Pediatric Appropriateness Evaluation Protocol , international studies have shown that 10-30% of hospital admissions are m edically unnecessary. Inappropriate hospitalizations have an economic impac t as well as medical and psychological effects on the child and the family. Objectives: To assess the extent and characteristics of inappropriate pedia tric admissions to a tertiary care facility in Israel. Methods: We conducted a prospective study using chart review of pediatric a dmissions to Soroka University Medical Center on 18 randomly selected days in 1993, and evaluated the appropriateness of admissions using the PAEP. Results: Of the 221 pediatric admissions 18% were evaluated as inappropriat e. The main reason for such an evaluation was that the problem could have b een managed on an ambulatory basis. Inappropriate admissions were associate d with hospital stays of 2 or less days, children older than I year of age, Jewish children, and self-referrals to the pediatric emergency room. Conclusions: The assessment and identification of characteristics of inappr opriate hospital admissions can serve as indicators of problems in healthca re management and as a basis for improving quality of care and developing a ppropriate medical decision-making processes.