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San Jose-Saras D, Vicente-Guijarro J, Sousa P, Moreno-Nunez P, Aranaz-Andres JM. Inappropriate hospital admission as a risk factor for the subsequent development of adverse events: a cross-sectional study. BMC Med 2023; 21:312. [PMID: 37592294 PMCID: PMC10433586 DOI: 10.1186/s12916-023-03024-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/07/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND All health overuse implies an unnecessary risk of patients suffering adverse events (AEs). However, this hypothesis has not been corroborated by direct estimates for inappropriate hospital admission (IHA). The objectives of the study were the following: (1) to analyze the association between IHA and the development of subsequent AEs; (2) to explore the distinct clinical and economic implications of AEs subsequent IHA compared to appropriate admissions. METHODS An observational cross-sectional study was conducted on hospitalized patients in May 2019 in a high-complexity hospital in Madrid, Spain. The Appropriateness Evaluation Protocol was used to measure IHA, and the methodologies of the Harvard Medical Practice Study and the European Point Prevalence Survey of Healthcare-associated Infections were used to detect and characterize AEs. The association between IHA and the subsequent. RESULTS A total of 558 patients in the hospital ward were studied. IHA increased the risk of subsequent occurrence of AEs (OR [95% CI]: 3.54 [1.87 to 6.69], versus appropriate) and doubled the mean AEs per patient (coefficient [95% CI]: 0.19 [0.08 to 0.30] increase, versus appropriate) after adjusting for confounders. IHA was a predictive variable of subsequent AEs and the number of AEs per patient. AEs developed after IHA were associated with scheduled admissions (78.9% of AEs, versus 27.9% after appropriate admissions; p < 0.001). Compared with AEs developed after appropriate admissions, AEs after IHA added 2.4 additional days of stay in the intensive care unit and incurred an extra cost of €166,324.9 for the studied sample. CONCLUSIONS Patients with IHA have a higher risk of subsequent occurrence of AE. Due to the multifactorial nature of AEs, IHA is a possible contributing factor. AEs developed after IHA are associated with scheduled admissions, prolonged ICU stays, and resulted in significant cost overruns.
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Affiliation(s)
- Diego San Jose-Saras
- Preventive Medicine and Public Health Service, Hospital Universitario Ramón y Cajal, IRYCIS, 28034, Madrid, Spain
- Universidad de Alcalá, School of Medicine and Health Sciences, Department of Medicine and Medical Specialities, Alcalá de Henares, Spain
| | - Jorge Vicente-Guijarro
- Preventive Medicine and Public Health Service, Hospital Universitario Ramón y Cajal. IRYCIS. CIBER of Epidemiology and Public Health (CIBERESP), 28034, Madrid, Spain.
- Faculty of Health Sciences, Universidad Internacional de La Rioja, 26006, Logroño, La Rioja, Spain.
| | - Paulo Sousa
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - Paloma Moreno-Nunez
- Preventive Medicine and Public Health Service, Hospital Universitario Ramón y Cajal, IRYCIS, 28034, Madrid, Spain
- Faculty of Health Sciences, Universidad Internacional de La Rioja, 26006, Logroño, La Rioja, Spain
| | - Jesús María Aranaz-Andres
- Preventive Medicine and Public Health Service, Hospital Universitario Ramón y Cajal. IRYCIS. CIBER of Epidemiology and Public Health (CIBERESP), 28034, Madrid, Spain
- Faculty of Health Sciences, Universidad Internacional de La Rioja, 26006, Logroño, La Rioja, Spain
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Morillo-Rodríguez A, Alonso-Fernández S, Mòdol Deltell JM, Soldevila Madorell B, Benito-Aracil L, Parés D. Strategies to improve the flow of admissions and hospital stays: A Delphi study of an adaptation of the Appropriateness Evaluation. Rev Clin Esp 2023; 223:270-280. [PMID: 37059299 DOI: 10.1016/j.rceng.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/28/2023] [Indexed: 04/16/2023]
Abstract
INTRODUCTION AND AIM The Appropriateness Evaluation Protocol (AEP) tool analyzes inappropriate hospital stays and admissions. This study aimed to adapt the AEP questionnaire in order to analyze the appropriateness of hospital admissions and stays in our healthcare reality. METHODS A study was conducted using the Delphi method in which 15 experts in clinical management and hospital care participated. The initial questionnaire items were taken from the first version of the AEP. In the first round, the participants contributed new items that they considered relevant in our current reality. In rounds 2 and 3, they evaluated 80 items according to their relevance using a Likert scale from 1 to 4 (maximum usefulness). Pursuant to the study's design, AEP items were considered adequate if the mean score according to the experts' evaluation was greater than or equal to 3. RESULTS The participants defined a total of 19 new items. In the end, 47 items earned a mean score greater than or equal to 3. The resulting modified questionnaire include 17 items in "Reasons for Appropriate Admissions," 5 in "Reasons for Inappropriate Admissions," 15 in "Reasons for Appropriate Hospital Stays," and 10 in "Reasons for Inappropriate Hospital Stays." CONCLUSIONS The identification according to expert opinion of priority items to determine the appropriateness of admissions and extended stays could be used in the future to help create an instrument to be used in our setting.
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Affiliation(s)
- A Morillo-Rodríguez
- Instituto de Investigación en Ciencias de la Salud Germans Trias i Pujol, Badalona, Barcelona, Spain; Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - S Alonso-Fernández
- Instituto de Investigación en Ciencias de la Salud Germans Trias i Pujol, Badalona, Barcelona, Spain; Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain; Departamento de Enfermería Fundamental y Médico-Quirúrgica, Facultad de Medicina y Ciencias de la Salud, Escuela de Enfermería, Universitat de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, Spain.
| | - J M Mòdol Deltell
- Instituto de Investigación en Ciencias de la Salud Germans Trias i Pujol, Badalona, Barcelona, Spain; Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain; Dirección Médica, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - B Soldevila Madorell
- Instituto de Investigación en Ciencias de la Salud Germans Trias i Pujol, Badalona, Barcelona, Spain; Dirección Médica, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain; Servicio de Endocrinología y Nutrición, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Ll Benito-Aracil
- Departamento de Enfermería Fundamental y Médico-Quirúrgica, Facultad de Medicina y Ciencias de la Salud, Escuela de Enfermería, Universitat de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, Spain; IDIBELL, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Spain
| | - D Parés
- Dirección Médica, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain; Servicio de Cirugía General y Digestiva, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain; Facultad de Medicina, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain
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Gómez Llorente JL, Bonillo Perales A, González-Ripoll Garzón M, Jiménez Liria R, Aguirre Rodríguez FJ, López Muñoz J. Utilidad del Pediatric Appropriateness Evaluation Protocol para detectar deficiencias de circuitos asistenciales hospitalarios. An Pediatr (Barc) 2004; 60:228-35. [PMID: 14987513 DOI: 10.1016/s1695-4033(04)78256-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES To quantify the number of inappropriate pediatric hospital admissions using the Pediatric Appropriateness Evaluation Protocol (pAEP), the causes of inappropriate admissions, and the clinical utility of the paep, as well as to detect deficiencies in the healthcare circuit in hospitalized pediatric patients. MATERIAL AND METHODS A prospective, descriptive study was carried out in a sample of 236 pediatric admissions. We analyzed several items such as age, pAEP, factors associated with inappropriate admission, main and secondary diagnoses, the diagnostic tests motivating admission, and day of the week and month of admission. RESULTS A total of 13.6 % (CI: 9.5 %-18 %) of pediatric admissions were inappropriate. The most frequent reasons for inappropriate admissions were diagnostic tests (2.5 %) and treatment (11 %) that could have been performed on an outpatient basis. Most (90.6 %) of the admissions deemed inappropriate by the pAEP were also considered inappropriate when evaluated by experienced pediatricians. CONCLUSIONS Improvement of healthcare circuits could decrease inappropriate admissions (better coordination between primary care and hospitals and improved access from the emergency unit to the specialized pediatric outpatient service). The pAEP allows identification of inappropriate admissions and their causes, as well as detection of deficiencies in the healthcare circuit.
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