The objective of this study was to analyze the variables related to inappropriate admissions and hospital stays and their financial repercussions. This was a descriptive retrospective study in which the Appropriateness Evaluation Protocol (AEP) was applied to a representative sample of 725 hospital admissions and 1350 hospital stays. The cost of inappropriate stays was calculated by cost accounting. The study found that 7.4% of admissions and 24.6% of stays were inappropriate. Inappropriate admissions were significantly related to medical specialties and younger patient age. Inappropriate stays were related to these factors, plus patients being outside their corresponding areas, nonurgent admissions, and low occupancy rate. The cost of the inappropriate admissions and stays was 147 044 euros. Extrapolated to the hospital as a whole this would represent 2125638 euros per year. Steps must be taken to reduce inappropriate admissions and stays to lower health care costs and to reserve hospital resources for patients who genuinely need them. (Am J Med Qual 2009;24:321-332)
Peiró S., Meneu R.Revisión de la utilización. Definición, concepto, métodos. Rev Calidad Asistencial. 1997;12:122-136.
2.
Gertman PM, Restuccia JDThe appropriateness evaluation protocol: a technique for assessing unnecessary days of hospital care. Med Care. 1981;19:855-871.
3.
Restuccia JA , Payne SMC, Lenhart G., Constantine HP, Fulton JPAssessing the appropriateness of hospital utilization to improve efficiency and competitive position. Health Care Manage Rev. 1987;12:17-27.
4.
Booth BM, Ludke RL, Fisher EMReliability of a utilization review instrument in a large field study . Am J Med Qual. 1994;9:68-73.
5.
Strumwasser I., Paranjpe NV, Ronis DL, Share D., Sell LJReliability and validity of utilization review criteria. Med Care. 1990;28:95-109.
6.
Kaya S., Vural G., Eroğlu K., et al. Liability and validity of the Appropriateness Evaluation Protocol in Turkey. Int J Qual Health Care. 2000;12:325-329.
7.
Lorenzo S., Lang T., Pastor R., et al. Reliability study of the European appropriateness evaluation protocol. Int J Qual Health Care. 1999;11:419-424.
8.
Peiró S., Meneu R., Roselló ML, Pontella E., Carbonell R., Fernández C.Validez del protocolo de evaluación de uso inapropiado de la hospitalización . Med Clin (Barc). 1996;107: 124-129.
9.
Callejas JL, Fernández A., Palmero C., Navarro MDSon realmente objetivos los criterios de adecuación hospitalaria del Appropriateness Evaluaron Protocol (AEP). Med Clin (Barc ). 2002;118:157-158.
10.
Lorenzo S.El retorno del AEP? Vigencia y cambios en su utilización. Rev Calidad Asistencial. 2002;17:587-588.
11.
Campos Rodríguez F., Cruz Morón I., Díaz Martínez A., López Rodríguez L., Muñoz Lucena F., Tejedor Fernández M.Adecuación de las estancias hospitalarias en un servicio de neumología. Arch Bronconeumol. 2007;43:439-444.
12.
Villalta J. , Sisó A., Cereijo AC, Sequeiro E., Sierra A.Adecuación de la hospitalización en una unidad de estancia corta de un hospital universitario. Un estudio controlado. Med Clin (Barc ). 2004;144:454-456.
13.
San Román Terán CM , Guil García M., Fernández Sepulveda S., Lorca Gómez J.Ingresos y estancias innecesarias en medicina interna. Med Clin ( Barc). 2002;118:157.
14.
Antón P., Peiró S., Aranaz JM, Calpena R., Compañ A., Leutscher E.Uso inadecuado de la hospitalización en cirugía general. Magnitud, factores asociados y causas. Cir Esp.2005 ;78:183-191.
15.
Rodríguez Vera FJ, Marín Fernández Y., Sánchez A., Borrachero C., Pujol de la Llave E.Adecuación de los ingresos y estancias en un Servicio de medicina interna de un hospital de segundo nivel utilizando la versión concurrente del AEP (Appropriateness Evaluation Protocol). An Med Int. 2003;20:297-300.
16.
Velasco Díaz L., García Rios S., Oterino de la Fuente D., Suárez García F., Diego Roza S., Fernández Alonso R.Impacto de los ingresos urgentes innecesarios sobre las estancias hospitalarias en un hospital de Asturias. Rev Esp Salud Pública. 2005;79:541-549.
17.
Dizdar O., Karadağ O., Kalyoncu U., et al. Appropriate utilization of hospital beds in internal medicine: evaluation in a tertiary care hospital. J Eval Clin Pract . 2007;13:408-411.
18.
Booth BM, Ludke RL, Fisher EMInappropriate hospital care and severity of illness: results from a nationwide study. Am J Med Qual. 1998;13:36-43.
19.
Panis LJ, Gooskens M., Verheggen FW, Pop P., Prins MHPredictors of inappropriate hospital stay: a clinical case study. Int J Qual Health Care. 2003;15:57-65.
20.
Payne SMC , Ash A., Restuccia JDThe role of feedback in reducing medically unnecessary hospital use. Med Care . 1991;29(8 suppl 1):91-106.
21.
Moya-Ruiz C. , Peiró S., Meneu R.Effectiveness of feedback to physicians in reducing inappropriate use of hospitalization: a study in a Spanish hospital . Int J Qual Health Care. 2002;14:305-312.
22.
Kossovsky MP , Chopard P., Bolla F., et al. Evaluation of quality improvement interventions to reduce inappropriate hospital use. Int J Qual Health Care. 2002 ;14:227-232.
23.
Negro Alvarez JM, Jimenez Molina JL, Félix Toledo R., et al. Adecuación de ingresos y estancias hospitalarias en pacientes con asma bronquial. Mejora de la gestión de las camas en la Sección de Alergología, tras la difusión de un estudio previo. Alergol Inmunol Clin. 2003;18:61-70.
24.
Wakefield DS , Pfaller MA, Hammons GT, Massanari M.Use of the appropriateness evaluation protocol for estimating the incremental costs associated with nosocomial infections . Med Care. 1987 ;25:481-488.
25.
Gianino MM, Vallino A., Minniti D., Abbona F.A model for calculating costs of hospital-acquired infections: an Italian experience. J Health Organ Manag. 2007;21(1):39-53.
26.
Feinstein AR , Cicchetti DVHigh agreement but low kappa: I. The problem of two paradoxes. J Clin Epidemiol. 1990; 43:543-549.
27.
Peiró S., Meneu R.Uso inapropiado de la hospitalización: problemas en los diseños muestrales . Gac Sanit. 1997;11:103-108.
28.
Lorenzo S.Revisión de la utilización de recursos: estudios realizados en España . Rev Calidad Asistencial. 1997;12:140-146.
29.
Meneu R., Peiró S.La revisión del uso apropiado de la hospitalización en España: de la comunicación científica a la utilización práctica? Todo Hospital. 1997;134:53-60.
30.
Matorras P. , de Pablo M., Otero L., Alonso F., Daroca R., Díaz- Caneja N.Adecuación de los ingresos en un servicio de medicina interna en un hospital de tercer nivel . Med Clin (Barc). 1990;94:290-293.
31.
Restuccia JA , Payne SMC, Lenhart G., Constantine HP, Fulton JPAssessing the appropriateness of hospital utilization to improve efficiency and competitive position. Health Care Manage Rev. 1987;12:17-27.
32.
Tamames S., Perez Rubio A., Castrodeza Sanz J., et al. Factors associated with the appropriate use of preoperatory hospital stays: historical cohort study. BMC Health Serv Res . 2007; 7:187.
33.
Zambrana García JL, Delgado Fernandez M., Cruz Caparrós G., Martín Escalante MD, Díez García F., Ruiz Bailén M.Factores predictivos d estancias no adecuadas en un servicio de medicina interna . Med Clin (Barc). 2001:117:90-92.
34.
Restuccia JD , Kreger BE, Payne SM, Gertman PM, Dayno SJ, Lenhart M.Factors affecting appropriateness of hospital use in Massachusetts. Health Care Financ Rev. 1986;8: 47-54.
35.
Oterino D., Peiró S., Portella E., Marchan C., Aymerich S.Utilización innecesaria de la hospitalización: importancia de la gestión a nivel de servicio. Am J Med. 1994;1:8-16.
36.
Carrasco L. , Flores B., Aguayo JL, et al. Contribution of the outpatient surgery unit into the general surgery department of a district hospital. Ambul Surg. 2000;8:158.
