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The authors declare that they have no competing interest.
VS conceived the study and participated in the design to draft the manuscript AC participated in the design of the study and performed the statistical analysis, giving final approval of the version to be published BF made substantial contributions to the conception and design of the manuscript. AM revised the manuscript critically for important intellectual content. MC participated in the sequence alignment and drafted the manuscript and gave final approval of the version to be published. JA participated in the sequence alignment and drafted the manuscript and gave final approval of the version to be published. All authors read and approved the final manuscript.
To reduce inappropriate admissions and stays with the application of an improvement cycle in patients admitted to a University Hospital. The secondary objective is to analyze the hospital cost saved by reducing inadequacy after the implementation of measures proposed by the group for improvement.
Pre- and post-analysis of a sample of clinical histories studied retrospectively, in which the Appropriateness Evaluation Protocol (AEP) was applied to a representative hospital sample of 1350 clinical histories in two phases. In the first phase the AEP was applied retrospectively to 725 admissions and 1350 stays. The factors associated with inappropriateness were analysed together with the causes, and specific measures were implemented in a bid to reduce inappropriateness. In the second phase the AEP was reapplied to a similar group of clinical histories and the results of the two groups were compared. The cost of inappropriate stays was calculated by cost accounting. Setting: General University Hospital with 426 beds serving a population of 320,000 inhabitants in the centre of Murcia, a city in south-eastern Spain.
Inappropriate admissions were reduced significantly: 7.4% in the control group and 3.2% in the intervention group. Likewise, inappropriate stays decreased significantly from 24.6% to 10.4%. The cost of inappropriateness in the study sample fell from 147,044 euros to 66,642 euros. The causes of inappropriateness for which corrective measures were adopted were those that showed the most significant decrease.
It is possible to reduce inadequacy by applying measures based on prior analysis of the situation in each hospital.