title: Inappropriate admissions: thoughts of patients and referring doctors.
abstract: Research on inappropriate hospital admissions has tended to neglect the views of the referring doctors and the patients. In this study, the Appropriateness Evaluation Protocol was applied to a random sample of 102 emergency medical admissions. The patients and doctors were then presented with a list of possible alternatives to admission that might have been used at the point of referral. Case notes were available for 88 patients. As judged by these, 28% of admissions were inappropriate, the commonest reason being the potential for treatment or tests to have been performed as outpatient procedures; next commonest was the possibility of lower level care. The response rate to the questionnaires was about two-thirds, for both doctors and patients. Of the general practitioners and casualty doctors who responded, 60% specified alternatives to admission that they would have considered, and the equivalent figure for patients was 70%. For both groups the major preferences were same-day outpatient assessment and admission to a community hospital. Referring doctors and patients, in this survey, favoured alternatives to acute medical care in proportions much higher than that of supposedly inappropriate admission.
authors.affiliation: Bishop's Castle Medical Practice, Schoolhouse Lane, Bishop's Castle, Shropshire SY9 5BP, UK. jpcam@totalise.co.uk
authors.forename: J
authors.initials: J
authors.lastname: Campbell
mesh_terms: D001291:Attitude of Health Personnel; D003657:Decision Making; D004636:Emergency Service, Hospital / Q000592:standards; D004739:England; D006300:Health Services Misuse; D006801:Humans; D007297:Inpatients / Q000523:psychology; D008505:Medical Staff, Hospital / Q000523:psychology*; D010343:Patient Admission / Q000592:standards*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010821:Physicians, Family / Q000523:psychology*; D012017:Referral and Consultation / Q000592:standards