NDLI: Defining the appropriate use of community hospital beds.

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Rediscovering community hospitals.

Improving the diagnosis of childhood asthma.

Defining the appropriate use of community hospital beds.

High group A streptococcal carriage in the Orthodox Jewish community of north Hackney.

Childhood asthma: can computers aid detection in general practice?

The use of a screening questionnaire to identify children with likely asthma.

The association between daytime attendance and out-of-hours frequent attendance among adult patients in general practice.

Community hospitals for the new millennium.

Percutaneous endoscopic gastrostomies: attitudes of general practitioners and how management may be improved.

Consultations owing to adverse drug reactions in a single practice.

Treatment of acute otitis media: are children entered into clinical trials representative?

A continuous curriculum for general practice? Proposals for undergraduate-postgraduate collaboration.

GP use and views of an inner-city GP unit.

School students and the clinical arena.

What are GPs for?

Little evidence of safe injecting.

School students and the clinical arena.

Birmingham's condom distribution scheme--an opportunity to promote sexual health in a primary setting.

Proposed new law on manslaughter: implications for the NHS and doctors.

Sexual health promotion--inner-city style.

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Defining the appropriate use of community hospital beds.

Content Provider	PubMed Central
Author	Jay, T. Linsell, J. Foy, C. Donald, I. P.
Abstract	BACKGROUND: Patients of GPs who have access to community hospitals (CHs) as well as district general hospitals (DGHs) tend to spend on average more days in hospital each year. Increasing attention is being paid to the efficient management of medical admissions; however, there has been no previous prospective study investigating the appropriateness of CH admissions. AIM: To develop a protocol to assess the clinical appropriateness of admission and length of stay of patients in CHs and to simultaneously compare the appropriateness of admissions to all DGHs and CHs in the county. DESIGN OF STUDY: A protocol named Community Hospital Appropriateness Evaluation Protocol (CHAEP) was developed to assess CH admissions through a process of consultation and a series of pilot studies. The appropriateness evaluation protocol (AEP) was also reviewed and used to assess DGH admissions. SETTING: A prospective cohort of 440 DGH admissions from five DGH sites and 440 CH admissions from nine CHs. METHODS: The admissions were assessed and followed for 28 days. If an admission failed to satisfy any of the criteria then the researcher interviewed the clinician to decide whether it was justified to override the protocol and still classify the admission as appropriate. To assess validity, a proportion of these 'clinical overrides' and the researcher's classifications were reviewed retrospectively by a clinical panel. The kappa statistic was used to assess the level of agreement. RESULTS: Applying the CHAEP, 82% of CH admissions satisfied a criterion for admission and a further 3% were given clinical overrides. A lower intensity of care was required for the majority of the remainder while three admissions required DGH care according to AEP criteria. Sixty-eight per cent of bed days satisfied day-of-care criteria within CHAEP and only a further 2% were given clinical override. These results were similar to those found with the AEP at the DGHs where 75% of admissions (plus 16% given clinical override) and 55% of days-of-care (plus 20% given clinical override) satisfied the AEP criteria. The review panel generally did not agree with the clinician's use of the clinical override at the CHs. Agreement between research nurse and review panel was better for the AEP and DGH (kappa = 0.9, 95% confidence interval (CI) = 0.7-1.0) than for the CHAEP and CH (kappa = 0.37, 95% CI = 0.1-0.8). CONCLUSIONS: The CHAEP could be used to audit the appropriateness of admission and length of stay in CHs. Other health communities would need to review the CHAEP before it could be applied within their context.
Starting Page	95
File Format	PDF
ISSN	09601643
Journal	The British Journal of General Practice
Issue Number	463
Volume Number	51
Language	English
Publisher Date	2001-02-01
Access Restriction	Open
Subject Keyword	Research in Higher Education
Content Type	Text
Resource Type	Article
Subject	Family Practice

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