The hospital appropriateness evaluation protocol in elderly patients: a technique to evaluate admission and hospital stay

Sánchez-García, Sergio; Juárez‐Cedillo, Teresa; Mould-Quevedo, J; García-González, José Juan; Contreras-Hernández, I; Espinel-Bermúdez, María Claudia; Hernández-Hernández, Dulce Marı́a; Garduño-Espinosa, Juan; García-Peña, Carmen

doi:10.1111/j.1471-6712.2007.00528.x

Cited by 15 publications

(21 citation statements)

References 36 publications

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“…Consequently the rate of false negative could be underestimated. A second stage of this study could be to test the AEP criteria in the emergencies room [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…The size of the sample was estimated assuming that 10% of the hospital admissions are inappropriate [ 16 ], with an accuracy of 0.02 and a reliability level of 95%. The required sample was of 863 files, plus a 20% considering the exclusion criteria.…”

Section: Methodsmentioning

confidence: 99%

“…The version adapted to Spanish and validated in the elderly population by our Appropriateness Evaluation Protocol (AEP) group was used as a tool to determine hospitalization appropriateness of the study subjects [ 17 - 19 ]. The AEP was previously validated in elderly Mexican population in 2005 [ 16 ]. The first AEP set comprised 16 criteria that establish the need for hospitalization on the hospital admission day.…”

Section: Methodsmentioning

confidence: 99%

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Direct costs associated with the appropriateness of hospital stay in elderly population

Mould-Quevedo

García-Peña

Contreras-Hernández

et al. 2009

BMC Health Serv Res

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“…Consequently the rate of false negative could be underestimated. A second stage of this study could be to test the AEP criteria in the emergencies room [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Direct costs associated with the appropriateness of hospital stay in elderly population

Mould-Quevedo

García-Peña

Contreras-Hernández

et al. 2009

BMC Health Serv Res

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“…16 Our DoCS showed that the older patients were, the less likely they were to meet the criteria for acute care. When inpatients were grouped in 10-year age bands, it was found consistently that advancing age was associated with an increasing proportion not meeting the criteria (Fig 1).…”

Section: Resultsmentioning

confidence: 99%

Identifying reasons for delays in acute hospitals using the Day-of-Care Survey method

Reid

King

Mathieson³

et al. 2015

Clinical Medicine

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This paper describes a new tool called 'Day-of-Care Survey', developed to assess inpatient delays in acute hospitals. Using literature review, iterative testing and feedback from professional groups, a national multidisciplinary team developed the survey criteria and methodology. Review teams working in pairs visited wards and used case records and bedside charts to assess the patient's status against severity of illness and service intensity criteria. Patients who did not meet the survey criteria for acute care were identifi ed and delays were categorised. From March 2012 to December 2013, nine acute hospitals across Scotland, Australia and England were surveyed. A total of 3,846 adult general inpatient beds (excluding intensive care and maternity) were reviewed. There were 145 empty beds at the time of surveys across the nine sites, with 270 defi nite discharges planned on the day of the survey. The total number of patients not meeting criteria for acute care was 798/3,431 (23%, range 18−28%). Six factors accounted for 61% (490/798) of the reasons why patients not meeting acute care criteria remained in hospital. This survey gives important insights into the challenges of managing inpatient fl ow using system level information as a method to target interventions designed to address delay.

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“…Although the appropriateness of hospital admissions, particularly in elderly people, has been extensively investigated and standardized tools have been proposed for clinical use, they are likely poorly implemented in the current clinical practice, at least in our region. [23][24][25][26] It appears likely that these inappropriate admissions reflect the absence of immediately available alternative settings of chronic care for these older ill patients.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of and factors associated with prolonged length of stay in older hospitalized medical patients

Fonte

Pivaro

et al. 2015

Geriatrics Gerontology Int

103

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Aim:To characterize elderly medical patients and identify factors associated with prolonged length of stay. Methods:The present prospective observational study evaluated consecutive patients aged ≥65 years admitted in acute geriatric and medical wards. A comprehensive assessment including demographic, clinical, functional and cognitive variables was carried out. Delayed discharge was defined when patients were discharged later than the date they were deemed medically ready for discharge by physicians. The analysis was initially carried out on the total sample and subsequently according to whether hospital admission had been from home, or from intermediate or long-term facilities.Results: Among 1568 patients (age 81.3 ± 7.3 years, 712 men), we observed a high prevalence of functional dependence, cognitive impairment, chronic immobilization and frailty (50%, 25%, 20% and 40%, respectively). Overall, delayed discharge occurred in 442 cases -resulting in 2637 days of prolonged hospital stay -and was independently associated with impairment in activities of daily living, frailty, high comorbidity and inappropriate admission. Among patients admitted from home (roughly 90% of the sample), delayed discharge occurred in 392 patients, and was independently associated with cognitive impairment, functional dependence, low severity of comorbidity and inappropriate admission (OR 3.39). Among patients admitted from intermediate or long-term facilities, lower cognitive impairment and greater severity of functional dependence were independently associated with prolonged stay. Conclusions:Poor health conditions and high prevalence of geriatric syndromes are extremely common among older medical inpatients. Delayed discharge was mainly observed in patients admitted from home, and associated with cognitive impairment (OR 1.12) and functional dependence (OR 1.49). Geriatr Gerontol Int 2015; 16: 314-321.

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The hospital appropriateness evaluation protocol in elderly patients: a technique to evaluate admission and hospital stay

Abstract: AEP's high-reliability and moderate-validity results with regard to clinical judgement positions it as a useful instrument for appropriate hospitalization screening in elderly patients.

Cited by 15 publications

References 36 publications

Direct costs associated with the appropriateness of hospital stay in elderly population

Direct costs associated with the appropriateness of hospital stay in elderly population

Identifying reasons for delays in acute hospitals using the Day-of-Care Survey method

Prevalence of and factors associated with prolonged length of stay in older hospitalized medical patients

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