Revue de pertinence des journées d’hospitalisation en médecine et chirurgie : un tiers de journées inappropriées au CHU de Nantes

Abstract

To assess the rate of inappropriate hospital days at Nantes University Hospital, to compare Internal Medicine and General Medicine departments to other hospital departments and to describe the main reasons for inappropriateness. A cross-sectional study was conducted during spring 2006, on a given day that differed in the 11 participating medical and surgical departments. All inpatients in the departments were included, except those admitted or discharged that day. The French version of the Appropriateness Evaluation Protocol was used to assess each day. Overall 32.4% of hospital days (71/219) (95% confidence interval: 26.1-38.7) were inappropriate. This rate did not vary significantly between internal and general medical, specialty, and surgical departments, although their inpatients had different characteristics. The risk factors for inappropriateness included long stays, unplanned admissions, behavioral disorders, and older age. Only a long stay was identified as a risk factor in all departments. Most of these inappropriate days (77.5%) were due to external causes (patients awaiting transfer). The decision of the patient (or family) was involved in 12.7%, and internal organizational reasons in 9.8%. This study showed a variety of risk factors for inappropriate days, differing according to department (except long stays, which were a risk factor in all departments). This confirms that patient characteristics play a major role, more significant than the department itself. Our analysis of the causes of these inappropriate hospital days, like those of most other studies, finds that only a few of these causes are susceptible to internal improvements. To optimize patient transfers, however, several units have begun training to make hospital staff aware of the importance of early planning. The impact of these measures on the number of inappropriate days should be assessed in the future.