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Appropriateness of admission and the last 24 hours of hospital care in medical wards in an East London Teaching Group Hospital

Appropriateness of admission and the last 24 hours of hospital care in medical wards in an East London Teaching Group Hospital
Appropriateness of admission and the last 24 hours of hospital care in medical wards in an East London Teaching Group Hospital
Objective: To assess the rates of inappropriateness of admission and last day of care on adult medical wards in an east London hospital, to identify associations with any inappropriateness and to assess what services need to be improved or provided if patients assessed as ''inappropriate'' are to be more appropriately placed in the future.Design: From the patients' medical notes, nursing notes and ward charts, a trained reviewer with nursing and university qualifications collected concurrent information about each patient's first 24 hours as an in-patient and about the last 24 hours of care preceding discharge, Patients were also interviewed before discharge and 7-10 days after discharge, and their health status and level of satisfaction about the discharge process assessed.Setting: The three adult medical wards at the Homerton Hospital in Hackney, east London, This hospital is within the St Bartholomew's Hospital Teaching Hospital Group.Subjects: The case-notes of a random sample of 625 adult in-patients were reviewed.End points: Appropriateness of admission and last day of care.Main outcome measures: The main instrument used was the Appropriateness Evaluation Protocol (AEP), This is an instrument devised to assess the appropriateness of adult patient admission to, and specific days of care in, acute hospital beds through case-note review against a structured set of criteria.Results: The study presented here reported that 31% of in-patient admissions to adult medical wards in an east London hospital were inappropriate, and also that 66% of the last days of stay were inappropriate.Conclusions: There is clearly considerable room for improvement in relation to cooperation between service providers in order to maximise efficient bed use, Delays due to waiting for medications from pharmacy, and the combination of more ''inappropriate'' cases wanting help from social services after discharge with the fact that many of them were still in hospital because they were waiting for these services to be organized, suggest that inappropriateness could be reduced through increased efficiency or increased provision in these areas, The study reported here is unique in its inclusion of patient interview data, Copyright (C) 1996 Elsevier Science Ltd.
evaluation protocol, experience, veterans, design
1353-4505
543 - 553
Houghton, Anita
b1a45440-ed9f-45db-905b-409c7a1efe5a
Bowling, Ann
796ca209-687f-4079-8a40-572076251936
Jones, Ian
a97b7bfd-c24c-45e6-8f67-8209777e6fe4
Clarke, Kim
2e04ee53-dc75-4294-bcca-fed396d7b4a3
Houghton, Anita
b1a45440-ed9f-45db-905b-409c7a1efe5a
Bowling, Ann
796ca209-687f-4079-8a40-572076251936
Jones, Ian
a97b7bfd-c24c-45e6-8f67-8209777e6fe4
Clarke, Kim
2e04ee53-dc75-4294-bcca-fed396d7b4a3

Houghton, Anita, Bowling, Ann, Jones, Ian and Clarke, Kim (1996) Appropriateness of admission and the last 24 hours of hospital care in medical wards in an East London Teaching Group Hospital. International Journal for Quality in Health Care, 8 (6), 543 - 553. (doi:10.1093/intqhc/8.6.543). (PMID:9007604)

Record type: Article

Abstract

Objective: To assess the rates of inappropriateness of admission and last day of care on adult medical wards in an east London hospital, to identify associations with any inappropriateness and to assess what services need to be improved or provided if patients assessed as ''inappropriate'' are to be more appropriately placed in the future.Design: From the patients' medical notes, nursing notes and ward charts, a trained reviewer with nursing and university qualifications collected concurrent information about each patient's first 24 hours as an in-patient and about the last 24 hours of care preceding discharge, Patients were also interviewed before discharge and 7-10 days after discharge, and their health status and level of satisfaction about the discharge process assessed.Setting: The three adult medical wards at the Homerton Hospital in Hackney, east London, This hospital is within the St Bartholomew's Hospital Teaching Hospital Group.Subjects: The case-notes of a random sample of 625 adult in-patients were reviewed.End points: Appropriateness of admission and last day of care.Main outcome measures: The main instrument used was the Appropriateness Evaluation Protocol (AEP), This is an instrument devised to assess the appropriateness of adult patient admission to, and specific days of care in, acute hospital beds through case-note review against a structured set of criteria.Results: The study presented here reported that 31% of in-patient admissions to adult medical wards in an east London hospital were inappropriate, and also that 66% of the last days of stay were inappropriate.Conclusions: There is clearly considerable room for improvement in relation to cooperation between service providers in order to maximise efficient bed use, Delays due to waiting for medications from pharmacy, and the combination of more ''inappropriate'' cases wanting help from social services after discharge with the fact that many of them were still in hospital because they were waiting for these services to be organized, suggest that inappropriateness could be reduced through increased efficiency or increased provision in these areas, The study reported here is unique in its inclusion of patient interview data, Copyright (C) 1996 Elsevier Science Ltd.

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Published date: 1996
Keywords: evaluation protocol, experience, veterans, design
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 334788
URI: https://eprints.soton.ac.uk/id/eprint/334788
ISSN: 1353-4505
PURE UUID: 0ec74a81-afff-465f-aab5-f4668fb7d821

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Date deposited: 22 Mar 2012 15:37
Last modified: 18 Jul 2017 06:11

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