An evaluation of the appropriateness of admissions to an Internal Medicine Service using an Appropriateness Evaluation Protocol during the year 2004

Abstract

Introduction: The Appropriateness Evaluation Protocol (AEP) is an
instrument to measure the appropriateness of admissions based on
criteria that permit classification of hospital admission as appropriate
or inappropriate. It also could be used to quantify and evaluate the
causes of inappropriate use of hospital resources.
Objective: Evaluate the appropriateness of hospital admissions of
patients admitted in a department of Internal Medicine during the year
of 2004, using the prospective version of the AEP.
Method: Prospective and random study of the patients admitted
in an Internal Medicine department during the year of 2004. We
analyzed demographic, clinical (readmissions, co-morbidility and
mortality) and administration parameters (hospitalization duration
and appropriateness of hospital admission using the AEP, including causes of inappropriateness).
Results: 72 patients fulfilled the inclusion criteria with an average
age of 70.6 years. 42% were readmissions. The average hospital stay
was 7.2 days. Mortality rate was 11.3%. 20.8% of the admissions
were considered inappropriate because they did not fulfill any AEP
criteria. The most common reason for inappropriate admission was
to perform diagnostic exams or treatments that could have been
done on an outpatient basis (53.3%).The most common criteria of
appropriateness was the need for intravenous therapy (87%), followed
by the need for assisted ventilation (12.3%).
Conclusions: The AEP allows us to evaluate the appropriateness
of hospital admissions in a Health Unit, enabling better utilization of
resources. A 20,8% rate of inappropriate admissions was recorded,
similar to that found in other studies. The creation of a structure that
improves the study of outpatient utilization could decrease inappropriateness of inpatient admissions.