[Impact on hospital days of care due to unnecessary emergency admissions].
BACKGROUND
Unnecessary admissions of acute cases have major impacts on hospital efficiency and organization. This study is aimed to identify percentage of unnecessary admissions from a hospital emergency department and the reasons why, as well as to quantify the unnecessary hospital days of care generated by these admissions.


METHODS
It has been analyzed the appropriateness of 622 admissions made in 2002, selected at random, all of the hospital stays generated by the inappropriate admissions and a representative sample of the appropriate admissions of a second-level hospital in Asturias. The review tool was the Appropriateness Evaluation Protocol. A descriptive analysis, a bivariate analysis and a multivariate logic regression analysis were made.


RESULTS
A total of 63 admissions (10.1%) were judged inappropriate. The main cause of inappropriateness were admissions for performing diagnostic tests and/or treatments, which could be carried out on an outpatient basis. These unnecessary admissions generated 78.2% of unnecessary stays, and the appropriate admissions generated 24.8% of unnecessary stays. Referrals to hospital emergency rooms from physicians outside of the hospital proper heightened the risk of unnecessary admissions (OR:4.50, 95% CI: 1.59-12.76), daytime admissions (OR: 13.97, 95% CI: 1.86-104.76) or evening admissions (OR: 7.70, 95% CI: 1.01-58.72), admissions to cardiology wards (OR: 3.93, 95% CI: 1.22-12.70) and neurology wards (OR: 5.86, 95% CI: 1.88-18.30), the experience of prior admissions having lowered the risk of unnecessary admission (OR: 0.34, 95% CI: 0.18-0.65).


CONCLUSIONS
Unnecessary admissions generate three times more inappropriate stays than the necessary admissions. Hospital organization-related problems are the main cause of inappropriate admissions.
Servicio de Urgencias, Hospital Valle del Nalón, Riaño, Asturias. luykys2@telefonica.net
Luis
L
Velasco Díaz
Susana
S
García Ríos
David
D
Oterino de la Fuente
Francisco
F
Suárez García
Susana
S
Diego Roza
Reyes
R
Fernández Alonso
D000293:Adolescent; D000328:Adult; D000368:Aged; D003627:Data Interpretation, Statistical; D004636:Emergency Service, Hospital; D005260:Female; D006300:Health Services Misuse; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D013030:Spain; D013997:Time Factors; D014600:Utilization Review