The Financial Burden of Inappropriate Admissions to Intensive Care Units of Shahid Faghihi and Nemazee Hospitals of Shiraz, Iran, 2014

Abstract

Background: Investigating the conditions and the appropriateness of admission of patients in hospitals is an important issue which can improve the efficiency of health care delivery. Intensive care unit (ICU) is important due to applying expensive financial sources; therefore, its efficient application is of great priority. In this regard, the current study aimed to determine the financial burden of inappropriate admissions in internal intensive care units (IICUs). Methods: It was a cross-sectional study conducted in 2014. A total of 294 patients admitted to IICUs of Shahid Faghihi and Nemazee hospitals of Shiraz, Iran, in 2012 were enrolled into this retrospective study. The study was conducted in two phases, using the guidelines of American critical care association (ACCA) and experts' opinion to investigate the financial burden of inappropriate admissions in IICUs of the above-mentioned hospitals. Results:The results showed no statistically significant relationships among insurance status, insurance type, age, gender and inappropriate admission by applying Chi-square. Among 294 admitted patients under the study, the inappropriate admissions were 11.2% based on the guidelines and 13.6% based on the experts' opinion. The level of agreement of the guidelines and experts' opinion for the inappropriate admissions was 0.076 based on Kappa coefficient. The total financial burden imposed on the insurance agencies and the patients by inappropriate admissions was US$ 47867.78 based on the guidelines and US$ 83241.68 based on the experts' opinion. Conclusions: Inappropriate admissions to ICUs may impose additional costs to the health system and the patients on one hand, and deprives other patients from receiving health services. Therefore, it is crucial to effectively plan for the application of ICU beds.

Evaluation of Inappropriate Admission and Hospitalization According to Appropriateness Evaluation Protocol and Estimation of Direct Financial Burden

“…In another study by Soria-Aledo et al to estimate inappropriate admissions employing AEP, this rate was equal to 7.4% (1). Several other investigations that did not use AEP for inappropriate admission estimation reported higher rates (14% -24%) than the current study (15,(20)(21)(22)(23). For instance, this rate was reported as 22% in a study by Eriksen et al in Norway (21).…”

“…In addition, the results of the study indicated that gender had no effect on the rate of inappropriate admission and days of hospital stay. Some studies also showed similar results (23,31); however, some other studies reported opposite results in this respect (25,32). The insurance state of patients had no effect on the prob-ability of inappropriate admission but had effects on inappropriate hospitalization.…”

Investigating inappropriate admissions and hospitalizations in Yasuj educational hospitals based on appropriateness evaluation protocol (AEP): A case study in the internal and surgical wards

“…Unnecessary hospitalization increases patient's costs, reduces the access of critically ill patients to existing resources, and increases the risk of hospital infections in hospitalized patients. Hence, examining the conditions for hospital admission and its appropriateness is one of the important issues that can improve the efficiency of hospitals . Furthermore, unnecessary presence of patients in hospitals may cause the inactivity of the community workforce and bring about related harm, occupational constraints, and negative emotional and psychological effects to the families…”

“…Hence, examining the conditions for hospital admission and its appropriateness is one of the important issues that can improve the efficiency of hospitals. 7 Furthermore, unnecessary presence of patients in hospitals may cause the inactivity of the community workforce and bring about related harm, occupational constraints, and negative emotional and psychological effects to the families. 8 Therefore, examining the conditions for hospital admission and its appropriateness, and continuous investigation of hospital services are important issues that can improve resource productivity, service quality, and hospital efficacy.…”

“…8 Therefore, examining the conditions for hospital admission and its appropriateness, and continuous investigation of hospital services are important issues that can improve resource productivity, service quality, and hospital efficacy. 6,7,9 Inappropriate use of hospital services includes the use of hospital resources for patients whose recovery is not affected by the services, or the use of services that could be provided at lower levels with the same quality and outcome. 10 On the other hand, excessive demands for hospitalization mean that patients receive unnecessary hospital services or pay more than they can afford.…”