Estimación de ingresos y estancias inadecuadas en un hospital comarcal

Abstract

An inappropriate hospital use, defined as hospital utilization that could have been occurred at a lower attending level or in less time, increases costs, creates inefficient management and influences on attending quality. The objective of this work was to evaluate the appropriateness and inappropriateness of hospital admissions and stays in a district hospital for acute patients as well as causes of such inappropriateness. Retrospective, descriptive study based on the review of clinical records of patients who required hospital admission. A sample of 378 patients representative of hospitalization for a 18-month period was selected. As measurement instrument the AEP (Appropriateness Evaluation Protocol) was used. This simple method has proved to be of high validity and reliability for the identification of inappropriate hospital use. The percentage of inappropriate hospital admissions detected was 13.8%, whereas the inappropriateness of hospital stays was 33.9%. As for clinical departments, the higher percentage of inappropriateness corresponded to the Traumatology Department (43%). The causes accounting for the inappropriateness of admissions related to the "necessity of admission"; but at a lower level, "diagnostic tests and/or therapy can be made on an outpatient basis" and "premature admission". As for hospital stays, the most common causes were "not rapid discharge", "diagnostic tests pending" and/or "any diagnostic and/or therapeutic procedure can be performed on an outpatient basis". The inappropriateness degree of hospital admissions and stays is similar to that observed in other more complex hospitals in our country. The causes underlying this phenomenon are dependent upon physician's decisions and social and public health conditions of the Area.