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
Autores principales: Lascano, Soledad, Morea, Gastón, Salomón, Susana
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Acceso en línea:https://bdigital.uncu.edu.ar/fichas.php?idobjeto=11572
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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.