Smith, H., Pryce, A., Carlisle, L., Jones, M., Scarpello, J. and Pantin, C. (1997) Appropriateness of acute medical admissions and length of stay. Journal of the Royal College of Physicians of London, 31 (5). pp. 527-532. ISSN 0035-8819Full text not available from this repository.
OBJECTIVE: To use the Appropriateness Evaluation Protocol (AEP) to assess the extent of inappropriate utilisation of hospital beds by acute medical patients. To determine whether clinicians viewed the AEP decisions as valid. DESIGN: Retrospective review of the medical records of a 10% random sample of 8,210 patients admitted as medical emergencies. An objective independent review instrument (AEP) was used to assess the medical necessity for hospitalisation at admission and on each subsequent day. To test the validity of the screening instrument, a subsample of the reviewed records was further assessed by a panel of physicians. SETTING: A district general hospital in the West Midlands region of England. SUBJECTS: Eight hundred and twenty-one adult patients admitted to general medicine during one calendar year. MAIN OUTCOME MEASURES: Proportions of admissions and days of care for which inpatient medical care was judged appropriate. Reasons for inappropriate utilisation and potential bed-days that could be saved by the development and use of alternative services were also considered. Validity of the AEP was tested by assessing agreement between the majority decision of an expert panel and the criterion-based AEP decision. RESULTS: AEP identified 51/821 (6%) admissions and 2,195/4,885 (45%) days of care as inappropriate. Over half the patients had a hospital stay in which at least half the days were judged inappropriate. The commonest reason for inappropriate days was remaining in hospital after the medical purpose for admission had been accomplished. This accounted for 38% of inappropriate days reviewed. In validity testing there was a high level of agreement between the physicians and the AEP, with kappa values greater than 0.80 for admissions and days of care. CONCLUSIONS: The AEP is a valid and useful instrument for assessing the utilisation of acute medical beds in a NHS hospital. In this study acute medical admissions were largely appropriate at the time of admission but a substantial proportion of subsequent days of care was considered inappropriate by AEP criteria. Most inappropriate utilisation was due to organisational issues within the hospital. As a result of this study, several service and policy developments were identified that should improve the efficiency of bed utilisation at the hospital.
|Schools and Departments:||Brighton and Sussex Medical School > Primary Care and Public Health|
|Depositing User:||Jane Harle|
|Date Deposited:||07 Oct 2008|
|Last Modified:||30 Nov 2012 16:53|
|Google Scholar:||49 Citations|