[Analysis of the appropriateness of hospital admissions from emergencies]

Sarasqueta C, Cantera M K, Fdez. Penalva G, Huarte I, Pijoan J I, Soto A
Record ID 32002000726
Original Title: Análisis de la adecuación de las admisiones hospitalarias desde urgencias
Authors' objectives: By means of a systematic review, the aim is to determine the tools available to assess the appropriateness of hospital admissions, to perform a qualitative analysis of the degree of appropriateness and the existing alternatives. Observations have been made to quantify the appropriateness of admissions to Osakidetza hospitals and the level of care required in inappropriate cases. The admission criteria used were those contained in the AEP (Appropriateness Evaluation Protocol), which has been validated in one of the hospitals that have taken part n the study
Authors' results and conclusions: The AEP has been identified as the most appropriate tool because of the validity and reliability of the literature. The proportion of inappropriate admissions through the emergency services varies between 5 and 25%. The actions that reduce hospital admissions and/or costs include actions taken in Primary Health Care, the rapid action units in cases of patients with asthma, thorax pain units and home visits in the case of the elderly. The AEP validation study has shown a sensitivity of 54% and a specificity of 91%; the reliability among reviewers is good with a Kappa of 0.81. The weighted Kappa calculated in order to measure the reliability of the list of required forms of care is 0.7. The measured inappropriateness of Osakidetza is 4.2% (IC: 3-5.8%) which varies from 1.3 to 6.5% between hospitals. There are no significant differences between medical and surgery admissions. The required levels of care in 65% of inappropriate admissions were hospital out patients consultations and specialised health centres.
Authors' recommendations: 1. The utility of the AEP in the review of hospital use must be limited to its capacity as a screening tool, not as the sole criterion for decision-making. 2. 2/3 of the cases of inappropriateness identified would be avoided with an appropriate circuit of specialist consultations and complementary tests.
Authors' methods: Review of the bibliographical database and qualitative synthesis of the information. Study of the validity and reliability of the AEP in 90 cases selected from the Aránzazu Hospital. The ‘gold standard’ was established through the clinical judgement of three experts. Transversal observation study in a stratified random sample per centre and admission date of 900 admissions through the emergency services from May 1 to 15 1999 in Osakidetza hospitals.
Project Status: Completed
Year Published: 2001
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: Spain
MeSH Terms
  • Triage
  • Emergency Service, Hospital
  • Patient Admission
  • Emergency Service
Organisation Name: Basque Office for Health Technology Assessment
Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz
Contact Name: Lorea Galnares-Cordero
Contact Email: lgalnares@bioef.eus
Copyright: <p>Basque Office for Health Technology Assessment, Health Department Basque Government (OSTEBA)</p>
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