[Classification and monitoring of the appropriateness of emergency admissions in a tertiary hospital].
OBJECTIVE
To measure the appropriateness of hospital admissions, to classify its Clinical Services (CS) according to the level of inappropriateness, and to determine the usefulness of applying rapid assessment techniques (lot quality assurance sampling) in these types of measurements.


METHODS
A descriptive, retrospective study was conducted in a tertiary hospital to assess the clinical records of emergency admissions to the 12 CS with a higher volume of admissions, using the Appropriateness Evaluation Protocol (AEP). A four-level («A» to «D») increasingly inadequate admissions scale was constructed setting both standard and threshold values in every stratum. Every CS was classified in one of them using lot quality assurance sampling (LQAS). A total of 156 cases (13 cases from every CS) were assessed. The assessment effort (devoted time) was also estimated.


RESULTS
There were 22.4±6.3% of inadequate admissions. In the CS classification, 9 (75%) got a good or acceptable appropriateness level, and only 1 (8%) got an inacceptable level. The time devoted was estimated at 17 hours.


CONCLUSIONS
AEP is useful to assess the admission appropriateness and may be included in the «Emergencies» process management, although its variability prevents the use for external comparisons. If both LQAS and the appropriateness classification level and the global estimation (by unifying lot samples) are combined, the monitoring is affordable without a great effort. To extend these tools to other quality indicators requiring direct observation or clinical records, manual assessment could improve the monitoring efficiency.
Unidad de Calidad Asistencial, Área I Murcia-Oeste, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España. Electronic address: julioj.lopez-picazo@carm.es.
J J
JJ
López-Picazo Ferrer
Unidad de Calidad Asistencial, Área I Murcia-Oeste, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
N
N
Tomás García
Dirección médica, Área I Murcia-Oeste, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
J D
JD
Cubillana Herrero
Dirección médica, Área I Murcia-Oeste, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
J A
JA
Gómez Company
Unidad de Calidad Asistencial, Área I Murcia-Oeste, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
J
J
de Dios Cánovas García
D000328:Adult; D003953:Diagnosis-Related Groups; D004630:Emergencies / Q000145:classification*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006753:Hospital Records; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D008485:Medical Audit; D008487:Medical History Taking; D010343:Patient Admission / Q000592:standards / Q000706:statistics & numerical data*; D017064:Process Assessment, Health Care / Q000379:methods; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000379:methods; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D013030:Spain; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*
Adecuación ingreso; Appropriateness admissions; Lot quality acceptance sampling; Monitoring; Monitorización; Muestreo por aceptación de lotes