The pattern of care in the medical wards of a teaching hospital

The Appropriateness Evaluation Protocol was applied in the internal medicine unit of a major South African teaching hospital to determine the proportion of patient days justifying hospital care. A high proportion of total inpatient days was found to be justified (71%); this was similar to hospitals in the USA and better than a comparable hospital in the UK. Only a small proportion of the non-justified days (3%) was explained by the demographic and hospital variables examined. Inappropriate days occurred nearer the end of a stay, and were disproportionate in patients not from the city in which the hospital was situated. Cerebrovascular accidents accounted for close to 10% of total inpatient days. A significant proportion of patient days (23%) did not include a documented doctor contact. Nursing observations were applied routinely, with little association with other indicators of the severity of the patient's condition. This study method is simple, reliable, reproducible and informative. It should be used more widely as a means of launching discussion and evaluation of hospital activity, both in the public and the private sectors.