title: Underutilization of acute care settings in a tertiary care hospital.
abstract: OBJECTIVE
  To estimate underutilization of acute care settings in a tertiary care hospital.
  
  
  METHODS
  A retrospective and concurrent cohort study using chart reviews and the Intensity of service, Severity of illness, Discharge screen for Acute Care (ISD-AC(R)) tool to measure appropriateness of acute care for patients who were receiving care in a less acute setting, as an indicator of underutilization.
  
  
  METHODS
  A 450-bed tertiary care teaching hospital.
  
  
  METHODS
  Patients discharged from the emergency department, patients discharged from acute care inpatient units and patients in acute, non-critical care settings.
  
  
  METHODS
  None.
  
  
  METHODS
  The percentage of patients discharged from the emergency department who did not meet the criteria for acute care discharge screens; the percentage of patients discharged from an acute care inpatient unit who did not meet the criteria for discharge screens; and the percentage of patients who were in acute, non-critical care beds and who met the criteria for critical care.
  
  
  RESULTS
  It was found that six out of 168 patients [3.57%; 95% confidence interval (CI), 1.32-7.61%] did not meet the discharge screens at the time of discharge from the emergency department. Four out of 156 patients (2.56%; 95% CI, 0.70-6.43%) did not meet the discharge screens at the time of discharge from an acute care inpatient service and two out of 156 acute care patients (1.33%; 95% CI, 0.02-4.73%) who were in non-critical care beds met the criteria for critical care.
  
  
  CONCLUSIONS
  These findings of underutilization may help to quantitate an unmet need in health care.
authors.affiliation: Center for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada. btrerise@providencehealth.bc.ca
authors.forename: B
authors.initials: B
authors.lastname: Trerise
authors.forename: P
authors.initials: P
authors.lastname: Dodek
authors.forename: A
authors.initials: A
authors.lastname: Leung
authors.forename: J J
authors.initials: JJ
authors.lastname: Spinelli
mesh_terms: D000208:Acute Disease / Q000145:classification* / Q000628:therapy; D001955:British Columbia; D015331:Cohort Studies; D003211:Concurrent Review; D003422:Critical Care / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006302:Health Services Research; D006745:Hospital Bed Capacity, 300 to 499; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D010351:Patient Discharge / Q000592:standards* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014600:Utilization Review