Is hospital the right place? A survey of 'inappropriate' admissions to an inner London NHS trust

Abstract

Background: Acute hospital beds form an important health care resource. However, it is accepted that some beds may be used 'inappropriately' by patients who, although no longer requiring the facilities of an acute bed, cannot be discharged because of difficulties in organizing care at home or elsewhere.

Methods: Using the Oxford Bed Study Instrument, all admissions to an inner London NHS trust over a one-week period were classified as either appropriate or inappropriate.

Results: During the study week there were 689 in-patient admissions of which five were classed as inappropriate. Of the five inappropriate patients two were children and three were aged 65+. For one child the admission was for clear social reasons. However, the remaining four patients all presented a clear need for either respite or hospice care. Lack of provision of such facilities meant that they had to be admitted to an acute hospital bed.

Conclusion: Overall our study highlighted the comparative rarity of inappropriate admissions, but did indicate that such patients may have long lengths of stay or repeated admissions which, as well as the amount of resources involved, prevent the bed from being used by other patients.