Barriers to appropriate utilization of an acute facility

Area of Science:

• Health Services Research
• Healthcare Management
• Quality Improvement in Healthcare

Background:

• Professional Standards Review Organizations (PSROs) are tasked with ensuring appropriate health resource utilization.
• Identifying and addressing factors contributing to healthcare resource misutilization is crucial for PSROs to implement corrective actions.

Purpose of the Study:

• To identify and quantify the significance of factors leading to hospital bed misutilization.
• To analyze barriers preventing appropriate patient placement and resource allocation within a hospital setting.

Main Methods:

• A utilization review nurse coordinator assessed patient appropriateness for hospital care using Medicare levels of care criteria.
• Patient days were sampled to determine appropriate care location (hospital, SNF, home health, home care).
• Barriers to appropriate utilization were identified for patients deemed inappropriately located.

Main Results:

• Approximately 10% of the 1,902 sampled patient days were deemed inappropriate for hospital level of care.
• The primary barriers identified were the unavailability of skilled nursing facilities (SNFs) with adequate services and conservative medical management by attending physicians.

Conclusions:

• Hospital bed misutilization is influenced by external resource availability and physician practice patterns.
• Addressing SNF capacity and physician management strategies can reduce inappropriate hospital utilization.