Assessing the appropriateness of hospitalisation days in a French university hospital

Abstract

To assess the appropriateness of hospitalisation days, a cross-section study was conducted in a French university hospital. Concerning both medical and surgical wards, three days were randomly chosen from April to June 2001. A total of 2,180 hospitalisation days were evaluated in accordance with the French appropriateness evaluation protocol (AEPf) with 10.9 per cent in medicine and 7 per cent in surgery judged as inappropriate. The delay tool was used to identify the causes of inappropriate days. The first cause of delay (68 per cent) was the unavailability of outside care (UOC), respectively 83.2 per cent and 61.4 per cent in surgical and medical services. The UOC was more pronounced for patients living in Caen (34 per cent) which represented only 20 per cent of hospitalised patients in the university hospital of their city. These results allow for suggestions for services to improve organisation and bring arguments for better health care.

Identifying reasons for delays in acute hospitals using the Day-of-Care Survey method

“…The overall proportion of patients not meeting the criteria (23%, n=798) is less than the 36% reported in Australia by Dempsey,15 but not as low as the 7% found in a study of 2,180 hospital days in France, 7 although the latter excluded patients who stayed less than one day.…”

“…[4][5][6] The criteria have also been shown to reliably identify acuity of medical illness and, in one study, the presence of positive AEP criteria refl ected increased morbidity and mortality. 5 Since 1981, the AEP criteria have been used, or modifi ed for local use, in Italy, 6 France, 7 Belgium, 8 Holland, 9 Spain, 10,11 Germany, 12 Denmark 5 and Turkey. 13,14 Assessments in the UK include the 1997 national study of acute medical admissions conducted by the Royal College of Physicians of London, 4 which reviewed 4,885 days of hospital care against the AEP criteria.…”

Appropriate utilization of hospital beds in internal medicine: evaluation in a tertiary care hospital

“…In this study, as a part of the process analysis of the institutional quality management and promotion programme in our hospital, we aimed to assess the effectiveness of the use of hospital beds in internal medicine department using the Appropriateness Evaluation Protocol (AEP) [3] and the factors associated with inappropriate utilization. AEP was previously validated and used as a useful and reliable tool for assessment of hospital stay in many different countries [4–7], as well as in Turkey [8–10].…”

Revue de pertinence des journées d’hospitalisation en médecine et chirurgie : un tiers de journées inappropriées au CHU de Nantes

“…Une étude danoise a montré les problèmes liés aux structures alternatives, concernant aussi bien les services de soins de suite et réadaptation que les services de soins à domicile [9]. Dans une étude menée sur l'ensemble des services du CHU de Caen en 2001, l'attente d'une place dans un service de soins de suite était la cause la plus fréquente des journées inappropriées retrouvée à l'aide de l'outil Delay tool (68 %) [13]. La forte proportion observée dans notre étude s'explique peut-être par un effet déjà tangible du vieillissement de la population.…”

“…L'indisponibilité des structures d'hébergement d'aval relève directement de la planification régionale, aussi bien sanitaire que sociale, dans le cadre des Schémas régionaux d'organisation des soins (SROS). Ainsi, l'insuffisance du nombre de lits de soins de suite et de réadaptation dans l'aggloméra-tion et la région nantaise, pointée par le SROS III des Pays de la Loire, explique probablement une grande partie des journées non pertinentes identifiées dans notre enquête, comme dans l'étude menée au CHU de Caen en 2001 [13]. Au terme de la réflexion initiée au sein de l'établissement lors de cette revue de pertinence des journées d'hospitalisation, quelques pistes d'amélioration se profilent, au sujet de l'information délivrée au patient et à sa famille tout au long du séjour hospitalier, et de la préparation de la sortie.…”