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International Journal for Quality in Health Care 15:57-066 (2003)
© 2003 International Society for Quality in Health Care

Paper

Predictors of inappropriate hospital stay: a clinical case study

LAMBERT J. G. G. PANIS1, MARIEKE GOOSKENS2, FRANK W. S. M. VERHEGGEN3,4, PETER POP5,6 and MARTIN H. PRINS1

1Department of Clinical Epidemiology and Medical Technology Assessment
3Quality Council, University Hospital Maastricht
6Transmural and Diagnostic Center, University Hospital Maastricht, the Netherlands
5Department of Internal Medicine, University of Maastricht
2University of Maastricht
4Dutch Institute for Healthcare Improvement (CBO), Utrecht

Objective. To assess the reasons for inappropriate patient stay (IPS) and to identify possible predictors of this inappropriate stay.

Design. The reasons for IPS were analyzed in a cross-sectional survey at two surgical, one gynecologic and one obstetric ward, using a sample of 610 days of hospital stay by means of the Dutch Appropriateness Evaluation Protocol.

Setting. The study was conducted at the University Hospital Maastricht, a 715-bed hospital with a regional and teaching function, located in the southern part of The Netherlands.

Results. Results indicate that >20% of the hospital stay was inappropriate. The reasons for IPS were statistically significantly related to the patients’ age, the availability of home care and medical specialty. In a predictive model, only the specialty proved to be a predictor of IPS. Most of the IPS occurred during the first days of hospital stay and the days before the patient’s discharge.

Conclusion. A substantial proportion of hospital stay was found to be inappropriate, due to hospital procedures and the inability to refer patients to other care facilities or care providers. Analysis of the causes of IPS provided useful data for improvement actions. Efficient use of hospital resources should be promoted by reducing the delay in interventions and discharge procedures.

Keywords: appropriateness evaluation protocol, Dutch Appropriateness Evaluation Protocol, inappropriate patient stay


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