Inappropriate hospital days of a tertiary hospital in Shanghai, China

Abstract

Objective: This study aims to evaluate the prevalence of inappropriate hospital stays in a tertiary hospital in Shanghai, identify the causes for the inappropriateness and analyze the predictors.

Design: A retrospective review of medical records.

Setting: The cardiology and the orthopedics departments of a tertiary hospital in Shanghai, China.

Participants: About 806 patients discharged from the cardiology or the orthopedics department of a tertiary hospital from March 2013 to February 2014.

Interventions: Two reviewers audited 8396 hospital days of the cardiology department (n = 3606) and the orthopedics department (n = 4790) by adopting the Chinese Version of the Appropriateness Evaluation Protocol. Univariate and multivariate analysis were adopted to identify the predictors of higher levels of inappropriateness produced by internal causes.

Main outcome measure: The prevalence of inappropriate hospital days.

Results: It was found that 910 (25.2%) and 1940 (40.5%) hospital days were judged to be inappropriate in the cardiology and the orthopedics departments, respectively; and 753 (20.9%) and 1585 (33.1%) of these inappropriate hospital days were due to internal reasons, respectively. Awaiting tests, surgery or discharge were determined to constitute the main causes of inappropriateness for both departments. The predictors of higher levels of inappropriateness in the cardiology department were younger age, self-pay, outpatient admission and inappropriate admission. Self-pay, surgical and/or first-time admission patients exhibited the highest levels of inappropriateness in the orthopedics department.

Conclusions: The rates of inappropriateness in the involved departments were relatively high. Further interventions should be designed and implemented, accordingly.

Keywords: Appropriateness Evaluation Protocol; China; appropriateness; hospital; hospital days; utilization review.