JRSM > Volume 94, Number 12 > Pp. 628-631

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Inappropriate admissions: thoughts of patients and referring doctors

John Campbell MB DRCOG  

Bishop's Castle Medical Practice, Schoolhouse Lane, Bishop's Castle, Shropshire SY9 5BP, UK

Correspondence to: Dr J Campbell, Department of General Practice, Adelaide University, Adelaide, South Australia 5005E-mail: jpcam{at}totalise.co.uk

Research on inappropriate hospital admissions has tended to neglect the views of the referring doctors and the patients. In this study, the Appropriateness Evaluation Protocol was applied to a random sample of 102 emergency medical admissions. The patients and doctors were then presented with a list of possible alternatives to admission that might have been used at the point of referral.

Case notes were available for 88 patients. As judged by these, 28% of admissions were inappropriate, the commonest reason being the potential for treatment or tests to have been performed as outpatient procedures; next commonest was the possibility of lower level care. The response rate to the questionnaires was about two-thirds, for both doctors and patients. Of the general practitioners and casualty doctors who responded, 60% specified alternatives to admission that they would have considered, and the equivalent figure for patients was 70%. For both groups the major preferences were same-day outpatient assessment and admission to a community hospital.

Referring doctors and patients, in this survey, favoured alternatives to acute medical care in proportions much higher than that of supposedly inappropriate admission.

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