Inappropriate hospital use by patients needing urgent medical attention in Italy

Abstract

The purpose of this study was to determine the extent of inappropriate admissions and days of stay in acute beds of patients who were admitted to hospital after attending the emergency department for urgent medical attention in Italy. The medical records of all adult patients (aged 16 years and over) on one randomly preselected day during the period January-December 2001 were reviewed. The retrospective application was made using the Appropriateness Evaluation Protocol list of criteria. Overall, 28.4 and 75.7% of hospital admissions and days of stay, respectively, were judged to be inappropriate. Results of the multiple logistic regression analysis indicated that inappropriate admission was significantly more likely in patients who lived closer to hospital, in younger patients, in patients from lower socio-economic classes, and in patients who did not receive diagnostic procedures in the emergency department. The proportion of patients whose admission was considered inappropriate was significantly lower in medical specialties wards. The number of inappropriate hospitalisation days was significantly higher in younger patients, in those admitted inappropriately, and in patients sampled close to discharge (during the final-third of his/her stay). The number of inappropriate hospitalisation days was significantly lower in patients admitted to surgical and traumatology/orthopaedics and medical specialties wards. Our findings indicate the need for specific interventions to reduce the prevalence of inappropriate hospital use and to modify physicians' attitudes and behaviours.