Inappropriate hospitalization. Reasons and determinants

Fuente, David de la; Peiró, Salvador; Marchan, Catalina; Portella, Eduardo

doi:10.1093/eurpub/6.2.126

Cited by 24 publications

(7 citation statements)

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“…No overly influential data points were observed has been utilized. The 28.1% prevalence of inappropriate admissions found is consistent with the values of more than 15 years ago of 27.6% reported in a survey conducted in a Spanish university hospital [7] and of the 23% prevalence reported in a non-pregnant adult population in the USA [8].…”

Section: Discussionsupporting

confidence: 89%

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Inappropriate hospital admission: interaction between patient age and co-morbidity

et al. 2011

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The aim of the study is to determine the prevalence of inappropriate admission, and to identify the factors that influence appropriateness of hospital admission. Data were prospectively collected from all 345 consecutive patients admitted during the period of 1 month for acute hospital care at a 110-bed division of internal medicine using socio-demographic and medical information. Statistical analyses included χ2 tests, t tests, and logistic regression analyses. According to the European version of the Appropriateness Evaluation Protocol of hospital admission, 28.1% of medical admissions for acute care in the Central Hospital of Bolzano, Italy, have been classified as inappropriate. Factors that reduced appropriateness included female gender, age and chronic illness that are significantly associated with appropriateness of medical admission, whereas time of day or day of week of the emergency department (ED) visit does not influence appropriateness. In multiple logistic regression analyses, age and co-morbidity are not independently related to appropriateness, however, when tested for interaction, inappropriateness is significantly more frequent at a young age in the absence of co-morbidities, and, numerically most relevant, in elderly patients presenting with co-morbidities. In this evaluation of a single centre North Italian hospital admission, co-morbidity turns out to be an important age-dependent determinant of appropriateness. Although in the young age group, co-morbidity increases the likelihood of being appropriately admitted, the presence of chronic illness in the elderly increases the risk of inappropriate hospital use.

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Section: Discussionsupporting

confidence: 89%

“…In the same period in Italy, the percentage of inappropriate admissions ranges from 25 to 38% [6]. Both findings are consistent with values reported in other surveys conducted in Spain [7] and the US [8]. In those studies, old age per se is not reported as being responsible for inappropriate admissions for acute care.…”

Section: Introductionsupporting

confidence: 89%

Inappropriate hospital admission: interaction between patient age and co-morbidity

et al. 2011

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“…167,199,200,204 In the remaining three studies, calculations were also presented for the number of individuals to be sampled, from a single cluster, 198 from six hospitals, 176 and from four hospital departments. 183 The required number of clusters, or the number of individuals required, after adjusting for correlation of outcomes within clusters, were not reported. It has not been standard practice to report sample size calculations except for randomised trials, but the results of this survey suggest that methods to estimate the number of organisational clusters for inclusion in healthcare evaluation studies are generally not used, even though this may have a critical influence on the outcome of the evaluation.…”

Section: Lack Of Sample Size Calculationsmentioning

confidence: 99%

Methods for evaluating area-wide and organisation-based interventions in health and health care: a systematic review.

Ukoumunne¹,

Gulliford²,

Chinn³

et al. 1999

Health Technology Assessment

1,047

442

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T he overall aim of the NHS R&D Health Technology Assessment (HTA) programme is to ensure that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and work in the NHS. Research is undertaken in those areas where the evidence will lead to the greatest benefits to patients, either through improved patient outcomes or the most efficient use of NHS resources. The Standing Group on Health Technology advises on national priorities for health technology assessment. Six advisory panels assist the Standing Group in identifying and prioritising projects. These priorities are then considered by the HTA Commissioning Board supported by the National Coordinating Centre for HTA (NCCHTA). This report is one of a series covering acute care, diagnostics and imaging, methodology, pharmaceuticals, population screening, and primary and community care. It was identified as a priority by the Methodology Panel and funded as project number 94/09/01. The views expressed in this publication are those of the authors and not necessarily those of the Standing Group, the Commissioning Board, the Panel members or the Department of Health. The editors wish to emphasise that funding and publication of this research by the NHS should not be taken as implicit support for the recommendations for policy contained herein. In particular, policy options in the area of screening will be considered by the National Screening Committee. This Committee, chaired by the Chief Medical Officer, will take into account the views expressed here, further available evidence and other relevant considerations. Reviews in Health Technology Assessment are termed 'systematic' when the account of the search, appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others.

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“…Las hospitalizaciones inadecuadas en servicios médi-cos se mantienen entre el 10 y 20%, aunque algunos estudios han observado una disminución 9 . Las principales causas de inadecuación 4,5,[10][11][12][13] (ingresos para realizar procedimientos diagnósticos y/o terapéuticos que podrían realizarse ambulatoriamente, problemas de organización del hospital y el estilo de practica de los médicos) tampoco varí-an, y mientras que algunas intervenciones como el AdeQuos 14 o unidades de corta estancia han mostrado su efectividad 8 , otras como la retroinformación a los clínicos ofrecen resultados variables [15][16][17] .…”

Section: Introductionunclassified

“…La relevancia de los ingresos inadecuados se deriva del mayor número de estancias que originan 10,16,20 La muestra (n=622), estimada para cada uno de los servicios médicos con una precisión del 6%, un error alfa del 5% y una prevalencia de ingresos inadecuados del 15%, se estratificó por grupos de edad (15-44, 45-64, 65-74 y 75 y más), y se aumentó en un 10% para compensar posibles pérdidas. En los servicios de nefrología y endocrinología, con 28 y 35 altas respectivamente, se revisaron todas las altas.…”

Section: Introductionunclassified

Impacto de los ingresos urgentes innecesarios sobre las estancias hospitalarias en un hospital de Asturias

Díaz¹,

Rios²,

Fuente³

et al. 2005

Rev. Esp. Salud Publica

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RESUMENFundamento: Los ingresos innecesarios en los hospitales de agudos tienen importantes consecuencias sobre su eficiencia y organización. El objetivo de este estudio es identificar el grado de inadecuación de los ingresos realizados desde un servicio de urgencias hospitalario y sus causas, así como cuantificar las estancias inadecuadas generadas por estos ingresos.Método: Se evaluó la adecuación de 622 ingresos realizados en al año 2002 seleccionados aleatoriamente, y la del total de estancias generadas por los ingresos inadecuados y una muestra representativa de los ingresos adecuados de un hospital de segundo nivel de Asturias. El instrumento de revisión fue el Appropiateness Evaluation Protocol. Se realizó un análisis descriptivo de la muestra, un análisis bivariante y un análisis de regresión logística multivariante.Resultados: Se consideraron inadecuados 63 ingresos (10,1%). La principal causa de inadecuación fueron los ingresos para realizar pruebas diagnósticas y/o tratamientos que podrían realizarse de forma ambulatoria. Los ingresos innecesarios generaron un 78,2% de estancias innecesarias y los necesarios un 24,8%. Incrementaron el riesgo de ingresos innecesarios la derivación a urgencias desde consultas externas del propio hospital (OR:4,50, IC 95%: 1,59-12,76), ingresar en horario de mañana (OR: 13,97, IC 95%: 1,86-104,76) o tarde (OR: 7,70, IC 95%: 1,01-58,72), ingresar en los servicios de cardiología (OR: 3,93, IC 95%: 1,22-12,70) y neurología (OR: 5,86, IC 95%: 1,88-18,30) disminuyó el riesgo de ingreso innecesario la experiencia de ingresos previos (OR: 0,34, IC 95%: 0,18-0,65). Conclusiones:Los ingresos innecesarios generan tres veces más estancias inadecuadas que los necesarios. Los problemas organizativos del centro son la principal causa de ingresos inadecuados.Palabras clave: Alta del Paciente. Hospitales. Servicio de Admisión en Hospital. ABSTRACT Impact on Hospital Days of Care Due to Unnecessary Emergency AdmissionsBackground: Unnecessary admissions of acute cases have major impacts on hospital efficiency and organization. This study is aimed to identify percentage of unnecessary admissions from a hospital emergency department and the reasons why, as well as to quantify the unnecessary hospital days of care generated by these admissions.

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Inappropriate hospitalization. Reasons and determinants

Cited by 24 publications

References 0 publications

Inappropriate hospital admission: interaction between patient age and co-morbidity

Inappropriate hospital admission: interaction between patient age and co-morbidity

Methods for evaluating area-wide and organisation-based interventions in health and health care: a systematic review.

Impacto de los ingresos urgentes innecesarios sobre las estancias hospitalarias en un hospital de Asturias

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