Appropriateness of admission and hospitalization days in a specialist hospital

The assessment of hospital utilization is an important tool in the management of Hospital Health Care. The Authors examined the extent and the reasons of inappropriate hospital admission and stay in patients admitted to the Monaldi Hospital, Naples, Italy. Five hundred and thirty three medical records, were analysed. The survey was carried out in the period May-October 1999, using the italian version of the Appropriateness Evaluation Protocol (AEP) method. Of the admissions days, 15.8% were considered inappropriate; the most frequent cause of inappropriateness was waiting period for diagnostic test. The highest percentage of inappropriateness was found for females, for less serious pathologies and in the summer months. Compared to the admissions, the proportion of inappropriateness of the index days was higher (35.5%); the most frequent cause of an inappropriate day of stay was the persistence of mild symptoms which according to the attending physician justified prolonging the stay, while the same variables found for inappropriate admission (female sex, less serious pathologies and summer months) were related to inappropriateness of stay. This survey has allowed us to offer some useful suggestions with a view to making some of the activities of the "Monaldi Hospital" more efficient.