The characteristics and prognosis of patients fulfilling the Appropriateness Evaluation Protocol in a medical admission unit; a prospective observational study

Background: To examine the prognostic significance of fulfilling at least one of the Appropriateness Evaluation Protocol (AEP) criteria. Methods: Prospective observational cohort study at medical admission units at a regional teaching hospital in Denmark. 3,050 consecutively admitted patients were included, median age 66 (IQR: 50-77), 48% female. We assessed the fulfilment of the AEP criteria and mortality data, length of stay, readmissions and co-morbidity. We analyzed the association between day of admission and time of day and compared the opinion of the admitting doctors and nurses on the relevancy of admission. Results: 61.9% of the patients fulfilled the AEP criteria. Patients fulfilling were older (p < 0.001), had a higher in-hospital mortality (p < 0.001), a higher 30-days mortality (p < 0.001), a longer length of stay (p < 0.001), more readmissions within 30 days (p < 0.001) and higher co-morbidity (p < 0.001). There were no association between day of admission and fulfilment of AEP criteria, but significantly fewer patients fulfilled the AEP criteria in the morning hours (p < 0.05). The nurses found 79.1% of the admissions relevant with a sensitivity of 84.8% and a specificity of 30.1% with a Kappa of 0.16. The doctors found 76.2% of the admissions relevant with a sensitivity of 86.4% and a specificity of 40.9% and a Kappa of 0.29. Conclusions: Fulfilment of the AEP criteria adequately reflect increased morbidity and mortality of acutely admitted medical patients.