Causes of inappropriate hospitalization and direct financial burden: Evidence from an Iranian burns hospital

Inappropriate hospitalization is a significant issue that imposes medical and financial pressure on hospitals, patients, and payers. By addressing this issue, healthcare costs can be minimized, while maintaining the quality of services. This study aimed to identify factors causing inappropriate hospitalization of burns patients and to calculate the financial burden associated with it in a hospital in Iran.

This is mixed methods study conducted during 2024-2025. The quantitative phase focused on the medical records of hospitalized patients, from which 342 cases were selected. The medical records were evaluated based on the Appropriateness Evaluation Protocol. To investigate the causes of inappropriate hospitalization, a semi-structured interview was conducted with 11 senior and middle managers. Qualitative content analysis was used for data analysis.

About 24% of patients experienced at least one day of inappropriate stay, with approximately 4.5% of the total hospitalization days deemed inappropriate. Marital status, insurance status, and length of stay were significantly associated with the rate of inappropriate hospitalization (p < 0.05). The estimated annual number of inappropriate hospitalization days per patient was 1057 days, and the direct cost incurred by patients was 14,309,430,289 Rials ($24,902). The primary causes of inappropriate hospitalizations were attributed to care providers, service recipients, financial issues, and extra-organizational factors.

A significant percentage of burns patients experience unnecessary hospitalizations, leading to significant direct costs. Hospitals can further minimize unnecessary stays and reduce hospital costs by properly managing bed occupancy, monitoring medical staff and patients, and educating both groups.