Necessity of Admissions in Selected Teaching University Affiliated and Private Hospitals during 2007 in Shiraz, Iran

The use of acute hospital beds is an issue of concern both to policy-makers and practitioners. In most countries attempts are underway to improve efficiency in this sector. One of the most widely used instruments for assessing inappropriate hospital use is the Appropriateness Evaluation Protocol, which consists of a set of standards based on objective criteria relating the condition of the patient to the clinical services received. The aim of this study was to measure inappropriateness of admission and inpatient stays at four major hospitals in Shiraz, Iran. The results showed that 22% of the total admissions in four hospitals were rated as inappropriate. The most as well as the least inappropriate admissions were found in both teaching university affiliated hospitals. Our data has shown that a total of 29.6% (average 6.40%) of the hospital stays in the study population were judged to be inappropriate. The result of the Least Significant Difference Test indicated a significant association between the mean days of inappropriate stay and turn of admission in all hospitals. In the four hospitals, a significant association was observed between the inappropriateness of hospital stay, costs, and length of stay. Considering the findings of this study, in addition to other studies in Iran and other countries, we can conclude that the factors involving inappropriate admission of patients to hospitals are mostly similar. In order to solve this problem we can use strategies such as: improving the performance of the referral system, using standard criteria for an appropriate evaluation protocol by the medical staff, and extending outpatient diagnostic services to reduce inappropriate hospitalization.