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Appropriateness of pediatric admissions to a tertiary care facility in Israel
M Katz1, S S Warshawsky, A Porat
1Center for Medical Decision Making, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel.
Insights
Eighteen percent of pediatric hospital admissions were inappropriate, often because care could have been provided outpatient. Identifying characteristics of these unnecessary admissions can improve healthcare management.
Area of Science:
- Pediatric healthcare utilization
- Health services research
- Hospital administration
Background:
- Hospital admission appropriateness is crucial for clinical and economic efficiency.
- Rising emergency room use and hospital admissions in Israel include a significant number of inappropriate cases.
- International studies indicate 10-30% of pediatric admissions are medically unnecessary, impacting costs and patient well-being.
Purpose of the Study:
- To evaluate the prevalence and identify characteristics of inappropriate pediatric admissions.
- Focus on a tertiary care facility in Israel.
Main Methods:
- Prospective chart review of pediatric admissions.
- Utilized the Pediatric Appropriateness Evaluation Protocol (PAEP).
- Study conducted at Soroka University Medical Center over 18 random days in 1993.
Main Results:
- 18% of 221 pediatric admissions were deemed inappropriate.
- Primary reason for inappropriateness: conditions manageable on an ambulatory basis.
- Inappropriate admissions linked to shorter stays (≤2 days), older children (>1 year), Jewish children, and self-referrals.
Conclusions:
- Characteristics of inappropriate admissions signal healthcare management issues.
- Findings can guide improvements in quality of care.
- Data supports development of better medical decision-making processes for pediatric admissions.
Background:
Appropriateness of hospital admission has both clinical and economic relevance, especially in light of the growing pressure for increased efficiency of health services utilization. In Israel, the number of referrals and use of the emergency room continue to rise along with an increase in hospital admissions and the number of inappropriate admissions. Using evaluation protocols, such as the Pediatric Appropriateness Evaluation Protocol, international studies have shown that 10-30% of hospital admissions are medically unnecessary. Inappropriate hospitalizations have an economic impact as well as medical and psychological effects on the child and the family.
Objectives:
To assess the extent and characteristics of inappropriate pediatric admissions to a tertiary care facility in Israel.
Methods:
We conducted a prospective study using chart review of pediatric admissions to Soroka University Medical Center on 18 randomly selected days in 1993, and evaluated the appropriateness of admissions using the PAEP.
Results:
Of the 221 pediatric admissions 18% were evaluated as inappropriate. The main reason for such an evaluation was that the problem could have been managed on an ambulatory basis. Inappropriate admissions were associated with hospitals stays of 2 or less days, children older than 1 year of age, Jewish children, and self-referrals to the pediatric emergency room.
Conclusions:
The assessment and identification of characteristics of inappropriate hospital admissions can serve as indicators of problems in healthcare management and as a basis for improving quality of care and developing appropriate medical decision-making processes.