|Home | About | Journals | Submit | Contact Us | Français|
Despite the limitations of the study due to losses in follow-up, Dr Campbell (December 2001 JRSM1) reaches an important conclusion: a proportion of patients are inappropriately admitted to hospital. In a similar study2 we found that 13.4% of admissions to our internal medicine department were inappropriate; and again the main reason (66% in our study vs 64% in Dr Campbell's) was the potential for outpatient tests or treatments. Therefore we designed an interventional plan to decrease the inappropriateness. The first step was to create a ‘diagnostic orientation consultancy’. In this unit, two specialists in internal medicine have online and telephonic connection with all general practitioners and family physicians in our area, and median delay between this consultation and attendance of the patient is 36 h. The second initiative has been the opening of a ‘quick internal medicine consultancy’ whereby hospital doctors advise on minor and mild disorders in less than 48 h after referral from any department of the hospital (most are from the emergency department). In 2001, inappropriate admissions had decreased to 9.1%. This may mean that the Appropriateness Evaluation Protocol is not only a tool for measuring the overuse of hospital resources but also an instrument for designing new strategies to avoid such overuse.