To stay or not to stay. The assessment of appropriate hospital stay: a Dutch report

Int J Qual Health Care. 2002 Feb;14(1):55-67. doi: 10.1093/intqhc/14.1.55.


Objective: To adjust the adult-medical Appropriateness Evaluation Protocol (AEP) into a valid and reliable instrument for use in the Dutch health care system, to assess the appropriateness of hospital stay and to identify the causes of inappropriateness.

Design: The appropriateness of hospital stay was assessed in a cross-sectional survey on a sample of over 4500 days of stay using a modified, Dutch version of the Appropriateness Evaluation Protocol (D-AEP).

Setting: The appropriateness of stay was assessed in five internal and surgical departments for adult acute care in the University Hospital of Maastricht, a 700-bed hospital with a teaching and regional function, located in the southern part of the Netherlands.

Results: The results showed that over 20% of the hospital stay was inappropriate. Half of the inappropriate hospital stay (45.1%) was due to (internal) hospital procedures. The D-AEP proved to be valid (kappa = 0.76; 95% confidence interval (95% CI) 0.68-0.84), reliable (kappa = 0.84; 95% CI 0.75-0.93) and easy to use.

Conclusion: A substantial proportion of hospital stay was found to be inappropriate, due to hospital procedures and the inability to refer patients to other care facilities or care providers. The D-AEP can be used for monitoring the appropriate hospital stay and in detecting possible causes of inappropriate stay. Analysis of the causes of inappropriate hospital stay provided useful data for improvement actions.

Publication types

  • Validation Study

MeSH terms

  • Adult
  • Concurrent Review / methods
  • Concurrent Review / statistics & numerical data
  • Cross-Sectional Studies
  • Decision Support Systems, Clinical*
  • Health Services Misuse / statistics & numerical data*
  • Hospital Bed Capacity, 500 and over
  • Hospital Departments / statistics & numerical data*
  • Hospitals, University / statistics & numerical data*
  • Humans
  • Internal Medicine / statistics & numerical data
  • Length of Stay / statistics & numerical data*
  • Needs Assessment*
  • Netherlands
  • Neurology / statistics & numerical data
  • Neurosurgery / statistics & numerical data
  • Obstetrics and Gynecology Department, Hospital / statistics & numerical data
  • Reproducibility of Results
  • Surgery Department, Hospital / statistics & numerical data
  • Utilization Review / methods*
  • Utilization Review / statistics & numerical data