Evaluation of appropriate hospital admissions from a tertiary level hospital emergency department

Objectives: To estimate the percentage of inappropriate hospital admissions ordered by the emergency department of a tertiary care hospital and to assess the association between appropriateness and patient and care factors.

Methods: Cross-sectional study of 631 randomly selected admissions in 2011. The Spanish version of the Appropriateness Evaluation Protocol was used. We recorded patient characteristics (age, sex) and care factors (referred consultation or not, shift, day of the week, and level of demand for services). The unit of statistical analysis was an

admission episode. Associations were explored by multivariable regression analysis.

Results: We detected a rate of inappropriate admission of 15.2% (95% CI, 12.62%–18.23%). The most common reason for inappropriate admission was to perform diagnostic tests and/or procedures that could have been ordered through outpatient

clinics (59.4%). Patients who were appropriately admitted were significantly older, by a mean of 5.4 years (P=.005). Multivariable analysis found a positive association between appropriateness of admission and 2 variables: age (odds ratio [OR], 1.021; 95% CI, 1.008–1.035) and number of admissions daily (OR, 1.027; 95% CI, 1.001–1.053).

Conclusions: The rate of inappropriate admissions by our department is similar to the rates published for other Spanish hospitals. Organizational variables that our hospital can potentially improve are the main reasons behind inappropriate admissions. Age and the number of admissions daily were positively associated with appropriate admission.