Appropriateness of hospital use: comparison between elderly patients' point of view and a structured questionnaire

Abstract

Appropriateness of hospital use: comparison between elderly patients' point of view and a structured questionnaire SIR-Appropriate use of hospitalisation is a key issue in terms of healthcare resources utilisation and individual needs. Surprisingly, there are only few studies assessing appropriateness of hospital stay in subacute settings. The demographic transition is associated with an increasing number of elderly people with multiple chronic conditions, and a growing need for subacute beds [1, 2]. In addition, the need to bolster rehabilitation is increasingly recognised for ageing patients for whom post-acute care is a pressing health policy issue [3, 4]. Optimal use of hospital beds also remains a challenge because of possible conflicts between medical needs and patients' preferences. Optimised use can contradict patients' views about 'best care' in terms of investigation, treatment, timing or location; and it can decrease their satisfaction as they do not always understand or accept the criteria used to determine the appropriateness of hospital use. Except for rare studies, research on the appropriateness of hospital use relied on professional opinion and/or application of review tools, and neglected patients' views [5, 6]. This study aimed at investigating patients' opinions about the appropriateness of their hospital stay. It also compared this 'subjective' appraisal to an 'objective' evaluation. Methods Setting The study was undertaken in the geriatric department of a university hospital. It was conducted in a 98-bed subacute ward where patients are either transferred from acute care wards (about 2/3) or directly admitted from the emergency room (about 1/3). The median length of stay (LOS) is 15 days and the mean is 21 days.

‘Acopia’ and ‘social admission’ are not diagnoses: why older people deserve better

“…The language used -for instance 'bed-blocker' 30 and 'inappropriate admission' 3,4 -and contractual mechanisms designed to incentivize admission avoidance or earlier discharge of older patients from hospital, all reinforce the premise that older people are somehow a 'problem', impairing the functioning of the system by their very presence. 31 Of course, patients of any age should not be in hospital beds unnecessarily.…”

An investigation into the construction industry’s view on fire prevention in high-rise buildings post Grenfell

“…All participants were told that all data collected would be disposed of securely, and that all personal details would be kept strictly confidential. As a vehicle for questionnaire delivery, the on-line portal consisted of close ended questions to secure a high response rate (Luthy et al, 2007). Structured questionnaires were used in industry and a HEI setting to assess whether participants kept abreast of contemporary fire safety issues.…”

Social admissions of the elderly: More medical attention should be paid

“…It has been reported that 88% of patients within 48 hours of admission and 85% of patients at 14th day of admission felt that their hospital use was justified, but the appropriateness determined by the appropriateness evaluating protocol was only 37%. 17 Medically inappropriate use of hospital beds can be presented in another form by delaying the discharge instead of increasing admissions. 18 Interestingly, inappropriate medical admission rate was not increased although the acute hospital admission rate was increased, 19 but the medically inappropriate admission was very common among elderly patients with a hospital stay longer than 30 days.…”