Background This study aimed to identify predictors of inappropriate hospital days in a department of internal medicine, as a basis for quality improvement interventions.
Methods The appropriateness of 5665 hospital days contributed by 500 patients admitted to the Department of Internal Medicine, Geneva University Hospitals, Switzerland, was assessed by means of the Appropriateness Evaluation Protocol.
Predictor variables included patient's age and sex, manner of admission and discharge, and characteristics of hospital days (weekend, holiday, sequence).
Results Overall, 15% of hospital admissions and 28% of hospital days were rated as inappropriate.
In multivariate models, inappropriate hospital days were more frequent among patients whose admission was inappropriate (odds ratio [ORI=5.3,95% CI : 3.1-8.4) and among older patients (80-95 years : OR=3.6,95% CI : 1.7-7.0, versus<50 years).
The likelihood of inappropriateness also increased with each subsequent hospital day, culminating on the day of discharge, regardless of the total length of stay.
Conclusions This study identified both the admission and the discharge processes as important sources of inappropriate hospital use in a department of internal medicine.
The oldest patients were also at high risk of remaining in the hospital inappropriately.
Surprisingly, long hospital stays did not generate a higher proportion of inappropriate days than short hospital stays. (...)
Mots-clés Pascal : Hospitalisation, Service hospitalier, Validité, Justification, Méthodologie, Evaluation, Homme, Epidémiologie, Suisse, Europe, Economie santé, Organisation santé
Mots-clés Pascal anglais : Hospitalization, Hospital ward, Validity, Justification, Methodology, Evaluation, Human, Epidemiology, Switzerland, Europe, Health economy, Public health organization
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0394913
Code Inist : 002B30A04B. Création : 25/01/1999.