A study of emergency admissions at the Flinders Medical Centre using the Appropriateness Evaluation Protocol

Abstract

ABSTRACTAnalysis of 3,046 consecutive admissions through the Emergency Department at Flinders Medical Centre was performed to determine whether they were valid acute admissions. The study period was 15th December, 1992 to 28th February, 1993. There was an average of 40.1 admissions from just over 140 presentations per day during this period.The admissions were reviewed against a modification of the Appropriateness Evaluation Protocol (AEP). This Protocol had been evaluated in a study for the Clinical Advisory Committee of the South Australian Health Commission. The modifications involved adding to the survey form criteria which had been accepted as overriding clinical reasons for admission in the Evaluation of the AEP report and conducting the survey prospectively as patients were admitted, rather than in a retrospective manner.Analyses were made of the day and time of day of admission. A separate analysis was conducted of patients referred by general practitioners (GPs). The busiest days were Sunday, Tuesday and Thursday, the busiest time for admission was 1600 to 2000 hours. For GP referred patients the quietest day was Sunday.Particular analyses were conducted on those criteria which had been added to the original AEP and on those patients who met none of the criteria, by definition, non acute admissions.There were very few non acute admissions through the emergency department. Only 83 patients (2.72%), met none of the 24 criteria, although many of these admissions could be justified on the basis that there were no viable alternatives to admission.If the AEP is to be used, the method chosen consumed fewer resources and provided the opportunity for more immediate analysis and feedback than the previous study.