A qualitative examination of inappropriate hospital admissions and lengths of stay

Abstract

BackgroundResearch has shown that a number of patients, with a variety of diagnoses, are admitted to hospital when it is not essential and can remain in hospital unnecessarily. To date, research in this area has been primarily quantitative. The purpose of this study was to explore the perceived causes of inappropriate or prolonged lengths of stay and focuses on a specific population (i.e., patients with long term neurological conditions). We also wanted to identify interventions which might avoid admission or expedite discharge as periods of hospitalisation pose particular risks for this group.MethodsTwo focus groups were conducted with a convenience sample of eight primary and secondary care clinicians working in the Derbyshire area. Data were analysed using a thematic content approach.ResultsThe participants identified a number of key causes of inappropriate admissions and lengths of stay, including: the limited capacity of health and social care resources; poor communication between primary and secondary care clinicians and the cautiousness of clinicians who manage patients in community settings. The participants also suggested a number of strategies that may prevent inappropriate admissions or reduce length of stay (LoS), including: the introduction of new sub-acute care facilities; the introduction of auxiliary nurses to support specialist nursing staff and patient held summaries of specialist consultations.ConclusionClinicians in both the secondary and primary care sectors acknowledged that some admissions were unnecessary and some patients remain in hospital for a prolonged period. These events were attributed to problems with the current capacity or structuring of services. It was noted, for example, that there is a shortage of appropriate therapeutic services and that the distribution of beds between community and sub-acute care should be reviewed.

Hospital admissions from nursing homes: a qualitative study of GP decision making

“…Lack of understanding of patients' prior state of health has been found to contribute to inappropriate hospital admissions from the community in a UK focus group study; 27 adequate healthcare records and advance planning documentation in anticipation of care management decisions are a common feature of palliative care initiatives. [16][17][18]28 Participants viewed the capability of nursing home care staff as a crucial factor in decision making and many suggested further training and support for nursing home staff.…”

Clasificación de las causas que determinan estadía inadecuada útil para la gestión hospitalaria

“…Estas causas incluyen: infecciones de heridas quirúrgicas, edad avanzada, alcoholismo, tabaquismo, alteraciones motrices, afección del sistema nervioso, ingresos en cuidados intensivos, presencia de comorbilidades, entre otras. [17][18][19] Al analizar las causas asociadas a las estancias inadecuadas, se observa que pueden ser producidas por dificultades que surgen antes del proceso de internamiento y que determinan la existencia de ingresos inadecuados, 20 y dificultades que surgen durante el proceso de internamiento y determinan la aparición de estadías inadecuadas.…”

“…En particular, se ha detectado que los retrasos en la toma de decisión médica y la incapacidad de establecer el diagnóstico correcto, son causas importante de inadecuación. [17][18][19][20][23][24][25]34 No menos importante es la diferencia de formación existente entre las distintas especialidades médicas. 35 …”

Consideraciones éticas en la gestión enfermera: una revisión actual

“…Se optimiza la disponibilidad y la ocupación hospitalaria, por lo que otros pacientes que esperan ser tratados tienen la oportunidad de ser ingresados y recibir la atención y los cuidados necesarios 35,36 .…”