A survey of the necessity of the hospitalization day in an Italian teaching hospital.
To assess the extent of inappropriate hospital use in an adult in-patients population we used a modified version of the Appropriateness Evaluation Protocol (A.E.P.) to evaluate retrospectively a cross-section of 273 patient-days in a large teaching hospital in the Greater Milan area. Overall, 41% were judged to represent inappropriate hospital use on the basis of the protocol's criteria. The rate of inappropriate hospital use was significantly associated with admitting specialty, ranging from 12% for surgery, to 20% for cardiology and to about 60% in psychiatric, geriatrics and neurology departments (p less than 0.01). Hospital days of patients with longer stays were more frequently inappropriate: a statistically significant trend of inappropriateness emerged ranging from 30% among patients with total length of stay (LOS) of 1-10 days to 60% among those with LOS greater than 30 days (p less than 0.01). This study confirms that there is a substantial rate of unnecessary use of hospitals but that such inappropriateness does not seem in most cases to be easily modifiable through "simple" organizational changes.
Apolone
G
G
Laboratorio di Epidemiologia Clinica, Istituto Ricerche Farmacologiche, Milano, Italia.
Alfieri
V
V
Braga
A
A
Caimi
V
V
Cestari
C
C
Crespi
V
V
Crosti
P F
PF
De Filippi
F
F
Gelosa
M
M
Lanzi
E
E
D000328:Adult; D003661:Decision Support Techniques; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006746:Hospital Bed Capacity, 500 and over; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D007902:Length of Stay / Q000706:statistics & numerical data; D008511:Medicine / Q000706:statistics & numerical data; D010865:Pilot Projects; D012189:Retrospective Studies; D013038:Specialization; D014600:Utilization Review / Q000706:statistics & numerical data*