Real association of factors with inappropriate hospital days.

Several studies of inappropriate (in the sense of the AEP) hospital days highlighted associations between two factors (rate of inappropriateness and reasons for inappropriateness, rate of inappropriateness and appropriate setting of care,..). The aim of this communication is to present a study on real associations, at constant factor, between five factors associated with hospital inappropriate days: medical management process, reason for inappropriateness, scheduled admission, rate of inappropriateness, length of stay. We used the European version of Appropriateness Evaluation Protocol for evaluation of inappropriate days and the French protocol ;for analysis of inappropriate days. The study set in three Parisian hospitals, four clinical departments, three specialities. 523 patients were included in the study, 5663 days were evaluated on a wide variety of pathologies: 27 Medical Management Processes. Results show that there are real associations (elimination of transitive associations) between five factors : medical management process and discharge processes, reason for inappropriateness, scheduled admission, rate of inappropriate days, length of stay. Multiple Correspondence Analysis on all "groups of contiguous days related with the same reason for inappropriateness" shows five profiles of queues integrating various medical management processes.

[Inappropriateness of hospital days and causes of failure in a Gastroenterology and Internal Medicine ward]. / Etude de la pertinence des journées d'hospitalisation dans un service de Gastroentérologie et Médecine Interne et analyse des causes de non-pertinence.

OBJECTIVES: To analyse patients' features linked to hospital inappropriateness and to highlight causes of inappropriate days in a Gastroenterology and Internal Medicine ward of a teaching hospital. METHODS: Appropriateness of patients' hospital days (2 months activity) was assessed using the French version of criteria of the Appropriateness Evaluation Protocol. Reasons of inappropriate hospital days were identified through a questionnaire based on patients' need. RESULTS: Two hundred and twenty patients were studied. Among the 2151 hospital days assessed, 880 (41%) were inappropriate. Two different groups of inappropriate stays were brought up. In the first group, the inappropriate period duration was short (<=5 days) and patients were not different from those of the appropriate group. In the second group, the inappropriate period duration was long ( > 5 days) and 710 days (33%) were inappropriate. Patients were elderly, lived alone and their disease did not concern the gastrointestinal tract. During inappropriate days, they expected access to less technical facilities than the short stay medical ward. CONCLUSION: The socio-demographic and medical features of the patients from the long duration inappropriateness group should help to limit inappropriate hospital days: a significant economic and organizational stake for patients, hospital and public interest.