[Characteristics of emergency room admissions of IDF soldiers in northern Israeli hospitals between May 2002 and April 2003].
BACKGROUND
The hospitalization rate of patients visiting the emergency room depends on various parameters including demography, clinical data and other variables. Long term follow-up of hospitalized IDF soldiers reflected variability in hospital admission rate among hospitals and raises the possibility of vastly inappropriate hospitalizations.


OBJECTIVE
The aim of this study was to characterize the admission policy for IDF soldiers in various hospitals, to assess the rate of inappropriate hospitalizations, and to evaluate these costs to the Medical Corps.


METHODS
Three hospitals in northern Israel were screened between May 2002 and April 2003, one urban tertiary care hospital (A) and two rural hospitals of different sizes (B and C). One fifth of the discharge forms were randomly screened. Every admission was given a risk evaluation based only on clinical data found upon presentation in the emergency room. One abnormal finding rendered the admission to be considered as appropriate. The rate of admission, lengths of stay, as well as clinical data and utilization of diagnostic tests were recorded and compared.


RESULTS
During the study period 65 +/- 1105, 39 +/- 536, and 54 +/- 485 Emergency Room visits were made monthly in hospitals A, B and C, respectively. A total of 1.0% +/- 6.5. 1.4% +/- 12.6 and 2.7% +/- 11.8 of these visits resulted in hospitalization in hospitals A, B and C, respectively. Approximately one quarter of the patients admitted to hospital A were low risk, compared to more than half in the rural hospitals. Low risk admissions were one day shorter in the urban hospital, whereas high risk admissions had the same length of stay. The cost of low risk admissions in the urban hospital was about half of its cost in any of the rural hospitals. The estimated annual cost of low risk admission in all three hospitals screened was about $US 1 million.


CONCLUSIONS
The admission rate in the urban hospital was half of its rate in the rural hospitals. Overall, 27% less low risk admissions were made in the urban hospital. The rural hospitals tendency to admit more low risk patients was compounded with their tendency to lengthen these admissions. The reason for this behaviour is not clear, although it may be related to differences in experience and clinical knowledge, consideration of the distance between the hospital and the soldier's home or unit, and financial admission policies.
Carasso
Shemy
S
Medical Services and Supply, Center Medical Corps, Israel Defense Forces, Israel.
Shmueli
Tali
T
Arnon
Ronen
R
Ashkenazi
Isaac
I
D004630:Emergencies / Q000453:epidemiology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006780:Hospitals, Rural; D006786:Hospitals, Urban; D006801:Humans; D007557:Israel; D008889:Military Personnel