Who should be admitted to hospital? Evaluation of a screening tool.
OBJECTIVE
To develop a tool for evaluating the appropriateness of acute hospital admissions in Hong Kong and test its reliability.


METHODS
The tool was based on the Appropriateness Evaluation Protocol and consensus of local Emergency Medicine specialists. Reliability was tested through retrospective chart review.


METHODS
Tertiary teaching hospital, Hong Kong.


METHODS
Seventy-five randomly selected patients, who were admitted to the specialty of Internal Medicine or General Surgery via the Accident and Emergency Department in 2006, were reviewed.


METHODS
The intra-rater and inter-rater agreement on appropriateness of an admission.


RESULTS
A 19-criterion protocol for assessing the appropriateness of acute hospitalisations was constructed. The kappa coefficient for intra-rater agreement was 0.73 (95% confidence interval, 0.58-0.88) and that for inter-rater agreement was 0.67 (95% confidence interval, 0.51-0.83).


CONCLUSIONS
The new protocol was shown to have substantial reliability for evaluating whether an acute hospital admission was appropriate. The findings in this study provide a basis for testing the validity of the new protocol as well as determining the extent of inappropriate acute hospital admissions in Hong Kong.
Leung
L P
LP
Accident and Emergency Department, Queen Mary Hospital, Pokfulam, Hong Kong. lpleung@yahoo.co.uk
Fan
K L
KL
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016001:Confidence Intervals; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006723:Hong Kong; D006760:Hospitalization / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008403:Mass Screening / Q000592:standards / Q000639:trends; D008499:Medical Records; D008875:Middle Aged; D015588:Observer Variation; D010343:Patient Admission / Q000706:statistics & numerical data*; D018579:Patient Selection; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D017749:Total Quality Management; D055815:Young Adult