Length of stay as risk factor for inappropriate hospital days: interaction with patient age and co-morbidity

Rationale, aims and objectives The likelihood of a hospital day being inappropriate depends on patient characteristics, on the organization of in-hospital care and on the co-ordination between hospital care and the rest of the health care sector. The aim of the study was to assess if certain socio-demographic and medical factors affect inappropriate hospital stay including possible interactions between age and co-morbidity. Methods To determine the appropriateness of length of hospitalization, a prospective study was carried out using the European version of the Appropriateness Evaluation Protocol (AEP). A total of 438 hospital days of stay was analysed in medical wards of a university-affiliated teaching hospital in the North of Italy for 3 days in September 2010. Results 44.6% of hospitalization days were classified as inappropriate. Unjustified hospital use was more frequent in patients whose hospital length of stay exceeded 10 days. Age and co-morbidity were not per se risk factors for inappropriateness; however, in young patients hospitalized for more than 10 days, absence of chronic illness was a predictor. Conservative patient management, lack of discharge planning and delays in scheduling diagnostic tests or therapeutic interventions were the most common causal or contributory doctor- and hospital-related factors. Conclusions Doctor attitudes and hospital organization are still among the most common reasons for inappropriate in-hospital days of care. Monitoring whether the length of stay is appropriate combined with protocol interventions for scheduling of diagnosis, treatment and discharge are likely to improve efficiency in this area of medical care.