Extramedical factors in the decision to hospitalize medical patients

This study assesses the importance of extramedical factors in the decision to hospitalize medical patients. Residents in a municipal hospital's emergency room completed a questionnaire on 252 consecutive patients at the time of admission. Extramedical factors contributed to the admission decision in 54 patients (21 percent); for twenty of these patients (8 percent of total) extramedical factors were the primary reason for admission. Factors noted most frequently related to patient behavior, such as being unlikely to follow instructions, and to home situations, such as social isolation. For 16 percent of the admissions, physicians felt that treatment outside the hospital was possible if realistic alternatives existed. Results suggest that extramedical factors are important contributors to the need for hospitalization. Attempts to develop quality assurance criteria, such as in utilization review or admission certification, must take such factors into account.