Appropriateness of admission and the last 24 hours of hospital care in medical wards in an east London teaching group hospital.
OBJECTIVE
To assess the rates of inappropriateness of admission and last day of care on adult medical wards in an east London hospital, to identify associations with any inappropriateness and to assess what services need to be improved or provided if patients assessed as "inappropriate" are to be more appropriately placed in the future.


METHODS
From the patients' medical notes, nursing notes and ward charts, a trained reviewer with nursing and university qualifications collected concurrent information about each patient's first 24 hours as an in-patient and about the last 24 hours of care preceding discharge. Patients were also interviewed before discharge and 7-10 days after discharge, and their health status and level of satisfaction about the discharge process assessed.


METHODS
The three adult medical wards at the Homerton Hospital in Hackney, east London. This hospital is within the St Bartholomew's Hospital Teaching Hospital Group.


METHODS
The case-notes of a random sample of 625 adult in-patients were reviewed.


METHODS
Appropriateness of admission and last day of care.


METHODS
The main instrument used was the Appropriateness Evaluation Protocol (AEP). This is an instrument devised to assess the appropriateness of adult patient admission to, and specific days of care in, acute hospital beds through case-note review against a structured set of criteria.


RESULTS
The study presented here reported that 31% of in-patient admissions to adult medical wards in an east London hospital were inappropriate, and also that 66% of the last days of stay were inappropriate.


CONCLUSIONS
There is clearly considerable room for improvement in relation to cooperation between service providers in order to maximise efficient bed use. Delays due to waiting for medications from pharmacy, and the combination of more "inappropriate" cases wanting help from social services after discharge with the fact that many of them were still in hospital because they were waiting for these services to be organized, suggest that inappropriateness could be reduced through increased efficiency or increased provision in these areas. The study reported here is unique in its inclusion of patient interview data.
Houghton
A
A
Research Unit, Royal College of Physicians, London, UK.
Bowling
A
A
Jones
I
I
Clarke
K
K
D000328:Adult; D000368:Aged; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006302:Health Services Research; D006304:Health Status; D006757:Hospital Units / Q000592:standards / Q000706:statistics & numerical data*; D006770:Hospitals, Group Practice; D006784:Hospitals, Teaching; D006801:Humans; D007388:Internal Medicine; D007902:Length of Stay; D008131:London; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000592:standards*; D017060:Patient Satisfaction; D014600:Utilization Review