Assessing the utilization of in-patient facilities in a Canadian pediatric hospital

To validate the pediatric appropriateness evaluation protocol (P-AEP) for use in the Canadian health care system and then to use it to assess the extent of inappropriate utilization in a Canadian tertiary care pediatric facility.

The P-AEP was applied to a 10% random sample of all general pediatric admissions during 1990 and to a sample of 547 subsequent days of care. The reliability of the P-AEP was assessed using a subsample of 72 admissions and 72 days of care. Validity was tested by comparing the P-AEP judgment on a sample of 50 admissions and 50 days of care with the subjective opinion of panels of three pediatric staff physicians.

In the reliability test, there was a high level of agreement between the two independent observers applying the P-AEP. In validity testing, the physicians found a slightly lower rate of inappropriateness relative to the P-AEP, but the validity was good overall. In the main study, 136 of 477 admissions (29%) were found to be inappropriate. Factors associated with inappropriate admission included nonurgent or emergent admission, surgical (versus medical) cases, residence outside the Greater Vancouver area, and admission on Sundays or Mondays. Fifty-five percent of inappropriate admissions were judged necessary but premature, whereas 45% were judged medically unnecessary. Of 547 subsequent days of care, 121 (22%) were found to be medically inappropriate. Inappropriate days of care were associated with girls, Mondays, and patients older than 14 years of age.

The P-AEP seems to be a valid and useful instrument for assessing the utilization of pediatric beds in a Canadian health care setting. Using the P-AEP made it possible to identify several service and policy developments which would help improve the efficiency of utilization at the hospital.