Appropriateness of Medical Admissions and of Continued In-Patient Stay at an Acute Hospital

Sir,

We read with interest the article by Evans et al in the IMJ1. We have also conducted a similar audit recently in St Columcille’s Hospital, Loughlinstown (SCHL) on appropriateness of admissions and of in-patient stay using the European version of appropriateness evaluation protocol (EU-AEP)2

There are only medical inpatients at this hospital so only the medical sections of the EU-AEP criteria were applied. All in-patients occupying a bed at 8 am on 6th August, 2015 were included. Patients in the medical assessment unit were excluded. Data was collected from patient notes and analysed in SPSS v17. Of 102 available beds, 72 beds were occupied. 38.8% (n=28) were males and 61.1% (n=44) were females. The mean age was 74.8 years and 72.2% (n=52) were aged above 65 years. Sources of referral were 41.67% (n=30) patients transferred from another hospital, 40.28% (n=29) general practice referrals and 18% (n=13) self-referrals. The commonest presentation was syncope, collapse or falls in 23.6% (n= 17) of admissions followed by sepsis 15.3% (n=11) and referral for rehabilitation (n=11). 56.9% (n= 41) patients fulfilled the EU-AEP admission criteria. 13.9% (n=10) of total patients met more than one EU-AEP admission criterion. Admissions might have been avoided in 11.1% (n=8) of patients if access to assessments and diagnostics was available at the time of admission. 31.9 % (n=23) of patients were admitted within the preceding 3 days. The mean length of in-patient stay was 34.47 days. 65.3% (n=47) of patients did not meet EU-AEP day of care criteria. 9.7% (n=7) of patients did not meet EU-AEP admission criteria but fulfilled EU-AEP day of care criteria. 25% (n= 18) were waiting for a nursing home bed. Other major discharge delay factors included investigations or their results 8.3% (n=6), awaiting home care package 8.3% (n=6) and awaiting consultant decision for discharge 6.94% (n=5). Evidence of discharge planning was seen in 79.2% (n=57) of total patients.

The number of cases outside admission EU-AEP were 43% (n=31), higher than the quoted Irish national average of 13%3. Those outside day of care EU-AEP were 65.3% (n=47), also higher than the quoted national average of 39%. These high percentages may be attributed to the additional role of this hospital as a transfer facility for patients with lower acuity from a level 4 hospital of the same hospital’s group and the designation of some beds exclusively for stroke and orthopaedic rehabilitation. There was good evidence of discharge planning in our audit (79.2% n=57) compared with quoted national figures of 40%3 and 48%1. This audit was a single snapshot which may not be wholly representative and the auditors were unblinded hospital employees. We plan to repeat the audit in a different month for comparison.

S Waqas, Z Galvin, VD Demirdal, T O’Connor, C Windrim, K McCormick, R Doyle, G Chadwick 

Department of Medicine, St Columcille’s Hospital Loughlinstown, Co Dublin; Ireland

Email: sarmadw234@gmail.com

References 

  1. Evans DS, Corcoran R, Kiernan R, Glacken M. A review of bed utilisation in the west of Ireland. Ir Med J. May; 108:142-4.
  2. Lang T,Liberati A, Tampieri A, Fellin G, Gonsalves Mda L, Lorenzo S, Pearson M, Beech R, Santos-Eggimann B. A European version of the Appropriateness Evaluation Protocol. Goals and presentation. The BIOMED I Group on Appropriateness of Hospital Use. Int J Technol Assess HealthCare. 1999 Winter; 15:185-97.
  3. PA Consulting Group Balance of Care Group. Acute hospital bed review: a review of acute hospital bed use in hospitals in the Republic of Ireland with an Emergency Department (summary, conclusions and recommendations). 2007; Available at: http://www.hse.ie/eng/services/publications/Hospitals/HSE_Publications/Acute_Hospital_Bed_Use_Review_Summary_Report.pdfAccessed 10/18, 2015.

p380