[Classification and monitoring of the appropriateness of emergency admissions in a tertiary hospital].

Autor:	López-Picazo Ferrer JJ; Unidad de Calidad Asistencial, Área I Murcia-Oeste, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España. Electronic address: julioj.lopez-picazo@carm.es., Tomás García N; Unidad de Calidad Asistencial, Área I Murcia-Oeste, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España., Cubillana Herrero JD; Dirección médica, Área I Murcia-Oeste, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España., Gómez Company JA; Dirección médica, Área I Murcia-Oeste, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España., de Dios Cánovas García J; Unidad de Calidad Asistencial, Área I Murcia-Oeste, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
Jazyk:	Spanish; Castilian
Zdroj:	Revista de calidad asistencial : organo de la Sociedad Espanola de Calidad Asistencial [Rev Calid Asist] 2014 Jan-Feb; Vol. 29 (1), pp. 10-6. Date of Electronic Publication: 2014 Jan 17.
DOI:	10.1016/j.cali.2013.05.002
Abstrakt:	Objective: To measure the appropriateness of hospital admissions, to classify its Clinical Services (CS) according to the level of inappropriateness, and to determine the usefulness of applying rapid assessment techniques (lot quality assurance sampling) in these types of measurements. Material and Methods: A descriptive, retrospective study was conducted in a tertiary hospital to assess the clinical records of emergency admissions to the 12 CS with a higher volume of admissions, using the Appropriateness Evaluation Protocol (AEP). A four-level («A» to «D») increasingly inadequate admissions scale was constructed setting both standard and threshold values in every stratum. Every CS was classified in one of them using lot quality assurance sampling (LQAS). A total of 156 cases (13 cases from every CS) were assessed. The assessment effort (devoted time) was also estimated. Results: There were 22.4±6.3% of inadequate admissions. In the CS classification, 9 (75%) got a good or acceptable appropriateness level, and only 1 (8%) got an inacceptable level. The time devoted was estimated at 17 hours. Conclusions: AEP is useful to assess the admission appropriateness and may be included in the «Emergencies» process management, although its variability prevents the use for external comparisons. If both LQAS and the appropriateness classification level and the global estimation (by unifying lot samples) are combined, the monitoring is affordable without a great effort. To extend these tools to other quality indicators requiring direct observation or clinical records, manual assessment could improve the monitoring efficiency. (Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.)
Databáze:	MEDLINE
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