Appropriateness of health care
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[edit] Appropriate health care
[edit] Appropriate Hospital Use
Research study on appropriate discharge and discharge delay
Objective
Survey ('one day census') in an acute hospital of whether patients in hospital over 28 days were appropriately still in acute hospital ward.
Methods
1. Patients were assessed using a questionaire from a survey in hospitals in Northern Ireland in 1970's(1) This questionnaire had questions based on a set of formal structured discharge criteria and a judgement on appropriately still in hospital calculated from a formal algorithm developed by a group of professionals in Northern Ireland ('the Northern Ireland criteria').
(1) Donaldson SN, Wheeler MR, Barr A. Demand for patient care. Br-Med-J 1977;6090:799-802.
2. For each of the patients, doctors and nurses were asked whether in their clinical opinion, the patient was still appropiately in the hospital or should have been discharged.
The conceptual framework was that the clinical judgement of the different groups of clinicians (doctor, nurse, etc) was dependent on what criteria were being used (implicitely) to make the judgement.
The hypothesis was that different groups of clinicians used various (and different) criteria in judging whether a patient could be discharged.
Results
Total patients > 27 days in hospital = 87
Data from doctors and nurses unknown = 6
Number (%) of patients judged as delayed
Judgements of the nurses 28 (32%)
Northern Ireland criteria 32 (37%)
Judgements of the doctors 37 (43%)
N. Ireland 'stricter' set 44 (51%)
