Inappropriate admissions: thoughts of patients and referring doctors

J R Soc Med. 2001 Dec;94(12):628-31. doi: 10.1177/014107680109401206.


Research on inappropriate hospital admissions has tended to neglect the views of the referring doctors and the patients. In this study, the Appropriateness Evaluation Protocol was applied to a random sample of 102 emergency medical admissions. The patients and doctors were then presented with a list of possible alternatives to admission that might have been used at the point of referral. Case notes were available for 88 patients. As judged by these, 28% of admissions were inappropriate, the commonest reason being the potential for treatment or tests to have been performed as outpatient procedures; next commonest was the possibility of lower level care. The response rate to the questionnaires was about two-thirds, for both doctors and patients. Of the general practitioners and casualty doctors who responded, 60% specified alternatives to admission that they would have considered, and the equivalent figure for patients was 70%. For both groups the major preferences were same-day outpatient assessment and admission to a community hospital. Referring doctors and patients, in this survey, favoured alternatives to acute medical care in proportions much higher than that of supposedly inappropriate admission.

MeSH terms

  • Attitude of Health Personnel*
  • Decision Making
  • Emergency Service, Hospital / standards
  • England
  • Health Services Misuse*
  • Humans
  • Inpatients / psychology
  • Medical Staff, Hospital / psychology*
  • Patient Admission / standards*
  • Patient Satisfaction / statistics & numerical data*
  • Physicians, Family / psychology*
  • Referral and Consultation / standards