Who should be admitted to hospital? Evaluation of a screening tool

Abstract

Objective: To develop a tool for evaluating the appropriateness of acute hospital admissions in Hong Kong and test its reliability. Design: The tool was based on the Appropriateness Evaluation Protocol and consensus of local Emergency Medicine specialists. Reliability was tested through retrospective chart review. Setting: Tertiary teaching hospital, Hong Kong. Patients: Seventy-five randomly selected patients, who were admitted to the specialty of Internal Medicine or General Surgery via the Accident and Emergency Department in 2006, were reviewed. Main outcome measures: The intra-rater and inter-rater agreement on appropriateness of an admission. Results: A 19-criterion protocol for assessing the appropriateness of acute hospitalisations was constructed. The kappa coefficient for intra-rater agreement was 0.73 (95% confidence interval, 0.58-0.88) and that for inter-rater agreement was 0.67 (95% confidence interval, 0.51-0.83). Conclusion: The new protocol was shown to have substantial reliability for evaluating whether an acute hospital admission was appropriate. The findings in this study provide a basis for testing the validity of the new protocol as well as determining the extent of inappropriate acute hospital admissions in Hong Kong.