Inappropriate hospitalization

The aims of this study are the identification of the reasons for inappropriate hospital utilization in a Spanish university hospital and the identification of the characteristics of the patients or of the hospitalization episodes associated with inappropriate hospital use. A concurrent review of 611 hospital stays was conducted, weighted by the proportion of beds in each group of hospital departments (n=334), by means of the appropriateness evaluation protocol (AEP), identifying the clinical need of each stay and assigning, in each case, reasons for unnecessary use. A descriptive analysis and logistic regression are presented to identify the determinants of unnecessary utilization. Of the hospital stays 43.9% were assessed as unnecessary. Almost 90% of unnecessary stays were attributed to the responsibility of the hospital, the department or the doctor, 2% to the socio-family background of the patient and 7.5% to lack of alternative hospital resources. Lack of family support, the assessment as unnecessary of the day of admission and the hospital department were significantly associated with inappropriate utilization, although the first factor has scarce practical relevance due to its low frequency. The results show the importance of unnecessary hospital utilization and the possibilities of designing specific measures for improving hospital efficiency.