Factors influencing the appropriateness of hospital stays

Characteristics of patient and healthcare service utilization associated with inappropriate hospitalization days

AIM

This paper is a report of a study to examine the number of inappropriate days of hospitalization and to identify the characteristics of patient and healthcare service utilization associated with inappropriate hospital stays.

BACKGROUND

Inappropriate hospitalization stays are recognized as an important indication of the misuse of healthcare services, but the published literature shows inconsistent findings on factors influencing this.

METHOD

A descriptive, correlational study was carried out in September 2005, with a patient survey and a review of patient records. Data were collected for 383 patients discharged from eight general nursing care units in a tertiary teaching hospital in Korea. Inappropriate hospitalization days were defined as inpatient days not requiring continuous and active medical, nursing or paramedical treatment provided by hospital services, and were judged using the Korean version of the Appropriate Evaluation Protocol. Univariate and multiple regression analyses were performed to determine factors associated with inappropriate hospitalization days.

FINDINGS

A total of 3076 hospitalization days were reviewed. The average proportion that were inappropriate was 5.1% (+/-16.0) per patient, and 14.1% of patients were determined to have had at least one inappropriate hospitalization day. The most common reason judged as appropriate was need for nursing/life support services. Statistically significant factors associated with inappropriate stay included gender, age, primary disease, length of stay and ward bed occupancy level during the patient's hospitalization.

CONCLUSION

Managers should take into account patient and clinical characteristics to promote better utilization of hospital resources.