title: Every seventh acute medical admission is preventable.
abstract: BACKGROUND
  The majority of patients who are admitted to the departments of internal medicine are admitted acutely. The aim of this study was to evaluate the appropriateness of admissions to a community hospital in Copenhagen.
  
  
  METHODS
  During a three-week period, all patients admitted to Bispebjerg Hospital's acute medical department (AMA) were consecutively included and retrospectively evaluated by a physician using the Appropriateness Evaluation Protocol (AEP). Based on the AEP criteria, admissions were categorized as appropriate or inappropriate. Uncertain admissions were evaluated and classified by three chief consultant physicians.
  
  
  RESULTS
  A total of 470 patients were included, and 14% were classified as inappropriate. A total of 73 admissions failed to met any AEP criteria, and 131 admissions only meet one AEP criterion. Prior to admission, 365 patients were examined by the admitting doctor, and of patients not examined before admission, 17 were classified as inappropriate. A total of 30% of all patients admitted were discharged directly from the AMA within 24-48 hours, and 42 of those were inappropriately admitted.
  
  
  CONCLUSIONS
  Our study shows that 14% of acute admissions could have been prevented. We found no evidence that preadmitting examination is important to prevent inappropriate admission. Several admissions could have been handled appropriately by a diagnostic unit or through sub-acute referral to an outpatient clinic the following day. The AEP is a useful screening instrument, but insufficient for the evaluation of the handling of acute medical patients.
  
  
  BACKGROUND
  not relevant.
  
  
  BACKGROUND
  not relevant.
authors.affiliation: Department of Endocrinology and Gastroenterolog, Bispebjerg Hospital, 2400 Copenhagen NV, Denmark. hksnit@gmail.com
authors.forename: Henrik Koldborg
authors.initials: HK
authors.lastname: Jepsen
authors.forename: Carsten
authors.initials: C
authors.lastname: Hendriksen
authors.forename: Henrik
authors.initials: H
authors.lastname: Nielsen
authors.forename: Birgitte
authors.initials: B
authors.lastname: Nybo
authors.forename: Hans
authors.initials: H
authors.lastname: Perrild
mesh_terms: D000208:Acute Disease; D003718:Denmark; D005260:Female; D006300:Health Services Misuse / Q000517:prevention & control / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007388:Internal Medicine / Q000706:statistics & numerical data; D008297:Male; D018579:Patient Selection; D012189:Retrospective Studies