Evaluación de estadísticas hospitalarias
Objective: To characterize hospital admissions in the Internal Medicine department of a general hospital. To analyze social, economic and environmental health factors implicated in the appropriateness of admission. Methods: Were included and registered demographic parameters, hospital admi...
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| Publicado en: | Revista Médica Universitaria |
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| Autores principales: | , , |
| Materias: | |
| Acceso en línea: | https://bdigital.uncu.edu.ar/fichas.php?idobjeto=11572 |
| Sumario: | Objective:
To characterize hospital admissions in the Internal
Medicine department of a general hospital. To
analyze social, economic and environmental
health factors implicated in the appropriateness of
admission.
Methods:
Were included and registered demographic
parameters, hospital admission characteristics
(workday vs weekend/holyday, routine vs
emergency, reasons of admission), educational
level, labor and habitational conditions,
comorbidities, autonomy (basic and instrumental
activities of daily living) and performance status. A
cross-sectional and descriptive study design was
employed. An Appropriateness Evaluation Protocol
(AEP) was used as a screening tool to evaluate
inadequate admissions. Data collected was
analyzed by Epi Info 7 software at descriptive and
analytical levels.
Results:
124 admissions were included, 53% male, average
age 52.5 years old (±15.2), 43% single and 38%
married. 12% with health insurance. 88.5% lived in
Gran Mendoza. 86% of the admissions were
registered during a workday, 94% for a clinical
reasons (19% dyspnea, 16%
disorders of consciousness and 10% fever). 5% of
admitted patients were asymptomatic. 50% of
patients were admitted by the emergency
department, 33% from outpatient clinics and 18%
from other departments. Illiterate 5%, complete
elementary school 22%, complete high school 14%
and university 2%. 25% were employed, only 15%
had employment stability. Retired 6%. 28%
received subsidy (10% for disability). 14% received
social support. 13% live alone. 21% were family
support, 20% referred child care
responsibility, and 5% disabled child care. 2% were
homeless. Without drinking water supply 8%, and
17.5% without connection to the sewage network.
Average Charlson score 4 points (± 2.1), APACHE II
score 11.5 points (± 6.1), BADL 4.1 (± 2.1) and IADL
3.9 (± 2.5). 33% of the hospital admissions were
inadequate according to the level of care facilities
offered at our institution. 71% could have been
carried out in a less complex institution. The main
reasons of inappropriate admissions were
conservative clinical observation in 36.5%,
persistence of clinical syndrome and waiting time
to consolidate treatment in 17%; followed by
homeless situation, waiting time for surgical
procedure, waiting time for orthopedic supplies,
risk for continuity of outpatient care, waiting time
for complementary diagnostic procedure and
limitation of the therapeutic efforts. The
comparative analysis between appropriate vs
inappropriate admissions proved that having a low
APACHE II score (p <0.01), living outside the
metropolitan region of Gran Mendoza (p <0.05),
and having a low educational level (p <0.01) were
significantly more frequent in patients with
inadequate admissions.
Conclusion
Inappropriate admissions rate was estimated to be
33% in our study. Having a low APACHE II score,
living outside the metropolitan region of Gran
Mendoza and having a low educational level, were
significantly more frequent in patients with
inadequate admissions. The pursuit for efficiency
in hospital management should motivate the use
of measurement and screening tools to detect
these inappropriate admissions. |
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