title: The characteristics and prognosis of patients fulfilling the Appropriateness Evaluation Protocol in a medical admission unit; a prospective observational study.
abstract: BACKGROUND
  To examine the prognostic significance of fulfilling at least one of the Appropriateness Evaluation Protocol (AEP) criteria.
  
  
  METHODS
  Prospective observational cohort study at medical admission units at a regional teaching hospital in Denmark. 3,050 consecutively admitted patients were included, median age 66 (IQR: 50-77), 48% female.We assessed the fulfilment of the AEP criteria and mortality data, length of stay, readmissions and co-morbidity. We analyzed the association between day of admission and time of day and compared the opinion of the admitting doctors and nurses on the relevancy of admission.
  
  
  RESULTS
  61.9% of the patients fulfilled the AEP criteria. Patients fulfilling were older (p < 0.001), had a higher in-hospital mortality (p < 0.001), a higher 30-days mortality (p < 0.001), a longer length of stay (p < 0.001), more readmissions within 30 days (p < 0.001) and higher co-morbidity (p < 0.001). There were no association between day of admission and fulfilment of AEP criteria, but significantly fewer patients fulfilled the AEP criteria in the morning hours (p < 0.05). The nurses found 79.1% of the admissions relevant with a sensitivity of 84.8% and a specificity of 30.1% with a Kappa of 0.16. The doctors found 76.2% of the admissions relevant with a sensitivity of 86.4% and a specificity of 40.9% and a Kappa of 0.29.
  
  
  CONCLUSIONS
  Fulfilment of the AEP criteria adequately reflect increased morbidity and mortality of acutely admitted medical patients.
authors.affiliation: Department of Medicine, Sydvestjysk Sygehus Esbjerg, Finsensgade 35, DK-6700 Esbjerg, Denmark. mikkel@brabrand.net
authors.forename: Mikkel
authors.initials: M
authors.lastname: Brabrand
authors.forename: Torben
authors.initials: T
authors.lastname: Knudsen
authors.forename: Jesper
authors.initials: J
authors.lastname: Hallas
mesh_terms: D000368:Aged; D003718:Denmark; D005260:Female; D006300:Health Services Misuse; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010343:Patient Admission / Q000592:standards*; D011379:Prognosis; D011446:Prospective Studies; D011795:Surveys and Questionnaires