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[Intensity of care during inappropriate hospital stay: Research Project in Nursing and Appropriateness Evaluation
L Ferrús1, G Honrado, M T Pescador
1L'Hospital de la Creu Roja. Lena.Ferrus@chcr.scs.es
Objective:
To determine the proportion of inappropriate hospital stays, their typology and the level of nursing care in Diagnosis Related Groups(DRG). To evaluate the use of the PRN (Project Research in Nursing) register forms, when determining AEP (Appropriateness Evaluation Protocol).
Method:
A cross-sectional study was performed on 494 patients classified with one of the 10 more frequent DRG in the hospital from February to July 1997. Information from patient clinical histories, PRN register forms, sociodemographic data, and nursing care activities were used. The appropriateness of hospital stay to AEP was assessed on the day prior to discharge. Comparison of inappropriate stays with appropriate stays was performed by chi-square test for categorical variables and Student t-test for continuous variables. The independent associated factors with inappropriateness of hospital stay, were estimated using a log regression model.
Results:
Out of 417 valid cases, hospital stay was considered appropriate in 269 (64.5%) patients and inappropriate in 148 (35.5%) patients. Mean-age of inappropriate stays was significantly higher than that of appropriate stays (70.06 +/- 13.84 vs 61.57 +/- 15.07, p < 0.05). Care intensity for inappropriate stays was larger than that of appropriate stays (median 137 [minimal value 45, maximal value 355] vs median 95 [minimal value 35, maximal value 131] p < 0.001). Care time in mobilization, elimination and hygiene activities was longer in inappropriate stays than in appropriate stays. In a log regression model, the age, feeding care intensity, therapy care intensity and DRG assigned to each process were independent predictive factors of inappropriate stays. For application of AEP, 56.9% of cases were reviewed using PRN register forms and 43.1% were reviewed using the case history.
Conclusions:
From the DRG examined, patients who undertook inappropriate stays consumed a large intensity of nursing basic activities; therefore, they may be candidates for receiving home care and/or sociosanitary care. PRN register forms afforded a decreased review time on applying the AEP.