Every seventh acute medical admission is preventable

Dan Med J. 2013 Mar;60(3):A4595.


Introduction: The majority of patients who are admitted to the departments of internal medicine are admitted acutely. The aim of this study was to evaluate the appropriateness of admissions to a community hospital in Copenhagen.

Material and methods: During a three-week period, all patients admitted to Bispebjerg Hospital's acute medical department (AMA) were consecutively included and retrospectively evaluated by a physician using the Appropriateness Evaluation Protocol (AEP). Based on the AEP criteria, admissions were categorized as appropriate or inappropriate. Uncertain admissions were evaluated and classified by three chief consultant physicians.

Results: A total of 470 patients were included, and 14% were classified as inappropriate. A total of 73 admissions failed to met any AEP criteria, and 131 admissions only meet one AEP criterion. Prior to admission, 365 patients were examined by the admitting doctor, and of patients not examined before admission, 17 were classified as inappropriate. A total of 30% of all patients admitted were discharged directly from the AMA within 24-48 hours, and 42 of those were inappropriately admitted.

Conclusion: Our study shows that 14% of acute admissions could have been prevented. We found no evidence that preadmitting examination is important to prevent inappropriate admission. Several admissions could have been handled appropriately by a diagnostic unit or through sub-acute referral to an outpatient clinic the following day. The AEP is a useful screening instrument, but insufficient for the evaluation of the handling of acute medical patients.

Funding: not relevant.

Trial registration: not relevant.

MeSH terms

  • Acute Disease
  • Denmark
  • Female
  • Health Services Misuse / prevention & control
  • Health Services Misuse / statistics & numerical data*
  • Hospitalization / statistics & numerical data*
  • Humans
  • Internal Medicine / statistics & numerical data
  • Male
  • Patient Selection
  • Retrospective Studies