Abstract
Background: Sláintecare is Irelands roadmap towards achieving Universal Healthcare Coverage, ensuring all patients receive the right care, in the right place, at the right time. The provision of Integrated Care in a setting as close to the home as possible is central to this. An acute hospital bed utilisation review can identify barriers and facilitators to streamlining Integrated Care transitions across care settings, as well as establishing a baseline of performance metrics allowing for meaningful comparisons over time.
Approach: The European Union Appropriateness Evaluation Protocol (EU-AEP) is an internationally recognised and validated tool used to assess the appropriateness of hospital admissions and hospital days of stay. (1) The EU-AEP consists of a set of criteria used to assess the clinical need for hospital admission and the level of care required based on the patients condition, clinical services and nursing/life support services. The study team consisted of multidisciplinary staff from the regional Department of Public Health, Hospital Group and Community services. Training materials and an electronic data collection tool were developed. Data were collected by trained Department of Public Health staff on three days in three acute hospitals with an emergency department in the South West of Ireland. All adult medical and surgical hospital inpatients on the day of the review were eligible for inclusion with the exception of patients in an intensive care unit, high dependency unit, obstetric ward, psychiatric ward and day ward. Each participant’s reason for admission and indication for ongoing acute hospital admission were reviewed against the EU-AEP criteria and deemed either ‘appropriate’ or ‘inappropriate’ by the data collectors. If an initial admission or ongoing stay was deemed ‘inappropriate’ a suitable alternative to acute hospital admission was selected. Data were exported to Microsoft Excel for analysis.
Results: 373 inpatients were included, representing 35% of the eligible population. 12% of patients were deemed ‘inappropriate’ admissions. The most common alternative identified to acute hospital admission was access to suitable community assessment and diagnostics. 45% of patients were deemed ‘inappropriate’ on the day of care, the most common alternative setting identified was a non-acute community bed with therapy support. The main factor affecting discharge for ‘inappropriate’ patients was awaiting review or assessment by a health care professional. 48% of patients reviewed had an estimated discharge date documented and 58% of patients had evidence of discharge planning.
Implications: Opportunities exist to improve acute hospital bed utilisation through the enhancement of Integrated Care. In particular by improving access to community assessment, diagnostics and alternative community beds which could prevent unnecessary hospital admissions and reduce length of stay. This review provides a performance benchmark and supports the optimisation of Integrated Care pathways that improve care coordination and care continuity between acute and community care settings.
References
1. Lang T, Liberati A, Tampieri A, Fellin G, Gonsalves MD, Lorenzo S, Pearson M, Beech R, Santos-Eggimann B. A European version of the appropriateness evaluation protocol: goals and presentation. International journal of technology assessment in health care. 1999 Jan;15(1):185-97.