Appropriateness of Hospital Admissions of Gastroenteric Patients via Emergency Services

Background and Purpose: To adapt and test the reliability and validity of the United States- Appropriateness Evaluation Protocol (US-AEP) instrument for screening emergency department admissions of gastroenteric patients in the context of a Taiwan hospital. Methods: A total of 341 patients (171 males; 170 females) receiving ED care in a 1,500-bed Christian Hospital located in central Taiwan were randomly selected. An appropriateness admission review of emergency department patients' medical records was reviewed by 2 physicians and 2 senior nurses based on Taiwanese version of the AEP (T-AEP). The percentage of inappropriate admission was calculated, the reliability, validity and practicality of T-AEP were evaluated, too. Results: 8.2% of hospital admissions were inappropriate. 63.2% of inappropriate admissions were related to diagnostic procedures and/or treatment that could have been done on an outpatient basis. The T-AEP proved to be valid [k=0.86; 95% confidence interval (CI), 0.77-0.95) and reliable (k=0.8; 95% CI, 0.69-0.92]. Conclusions: The T-AEP proved to be both a valid and reliable screening instrument for monitoring the appropriateness of hospital admissions. Understanding the reasons for inappropriate admissions provides important data for follow up quality improvement actions. Our experience shows that the US-AEP can be adapted to local conditions in other countries.