Inappropriate hospital admission as a risk factor for the subsequent development of adverse events

1. Patients with inappropriate hospital admission (IHA) experience twice more adverse events (AEs) on average than appropriately admitted patients. 

2. IHA is associated with longer ICU stays resulting from AEs compared to AEs experienced by non-IHA patients.

Evidence Rating Level: 2 (Good)

The concept of health overuse refers to when the harm outweighs the benefit to a patient when health services are provided, such as with inappropriate hospital admissions (IHA). Health overuse can result in adverse events (AEs), such as healthcare-associated infections. This current cross-sectional study aimed to examine the association between IHA and AEs, as well as its downstream implications. The setting of this study was a hospital in Madrid, Spain during one week in May 2019. To measure IHA, the study used versions of the validated Appropriateness Evaluation Protocol (AEP): IHA was thus defined as an admission that did not meet any one appropriateness criterion from the AEP. As well, validated tools from the Harvard Medical Practice Study (HMPS) and the European Point Prevalence Survey of Healthcare-associated Infections were used to measure AEs: The avoidability of AEs was scored from 1 to 6 using the HMPS tools. The study population included 558 eligible patients hospitalized during the week, 12.7% of which were deemed as IHA. 15.5% of the IHA patients experienced 1 or more AEs, compared to 10.7% of patients who were not IHA (p = 0.231). As well, IHA patients had twice more AEs per person than those who were not IHA (0.27 vs 0.12, p = 0.015). The odds ratio of an IHA patient experiencing an AE compared to a non-IHA patient was 2.26 (95% CI 1.26-4.04). The most frequent AEs were healthcare-associated infections (38.8%), procedural-related AEs (26.3%), and nursing care AEs (26.3%). AEs experienced by IHA patients were associated with more ICU days (mean 3.3 vs 0.9, p = 0.037), and incurred an average €12,600.40 for each extra day of hospitalization (€166,324.90 total for all extra days in the study). Overall, this study showed that IHA patients experience AEs more often than appropriately admitted patients, and can lead to longer ICU stays and additional financial costs.

Click to read the study in BMC Medicine 

Image: PD

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