An assessment of inappropriate hospital bed utilization by elderly patients in southern Italy

The aims of this study were to quantify the rate of inappropriate hospital admissions and days of stay among elderly patients, and to identify the main causes of such inappropriateness.

A random sample of 560 medical records of patients aged 65 and over, admitted to medical and surgical wards of a non-teaching hospital in Catanzaro (Italy) were reviewed (occupation rate: 81.9%, average length of stay: 5.6 days; hospitalization rate in the area: 130.8 per 1,000 inhabitants).

Of the 529 patient days reviewed, 9.8% of hospital admissions were judged to be inappropriate, and the level of inappropriate hospital days of stay was 39.5%. The inappropriateness of admission was significantly higher for younger patients and for those whose admission was programmed. Demographic and hospital variables were significant predictors of the risk of inappropriateness per day of care: women, those not living alone, patients admitted with a more severe burden of overall comorbidity, patients inappropriately admitted, and those sampled close to discharge were more likely to be classified as inappropriate. Inappropriate admission was due to premature admission, an overcautious physician's attitude in the management of a patient, and admission for a diagnostic or therapeutic procedure that should have been performed on an out-patient basis. The reasons for inappropriate hospital stay were: physician's lack of decision regarding discharge of a patient and delays in scheduling a diagnostic or therapeutic procedure.

Interventions are needed in order to increase the quality and efficiency of hospital care, by rectifying the attitudes and behaviors of Italian physicians.