Appropriateness of admission and hospital in obstetric wards: an Italian cross-sectional study comparing Sicilian setting

Abstract

Appropriateness is one of the main topics of health policy and should be estimable in order to analyze the efficacy of hospital services. The Review and Use of the Hospital Protocol (in Italian: Protocollo di Revisione dell’Uso dell’ Ospedale-PRUO) allowed us to evaluate the appropriateness of hospitalizations, starting from daily available clinical records in a selected hospital. Methods The cross-sectional study applied the PRUOmethod on a sample of medical records (N=575; years: 2008–2010) related to ordinary admissions to obstetric wards of Lipari and Pantelleria Hospital (both Minor Islands of Sicily: MI) and to the Teaching Hospital of the University of Palermo (P) in order to evaluate the incidence of appropriateness and to highlight the main factors related to inappropriateness. Results Statistical analysis showed a similar prevalence of inappropriate admissions in both groups (2–3 %). Significant differenceswere found in the prevalence of inappropriate days of hospitalization: 1st (P: 1 %; MI: 5.5 %; p=0.018), 2nd (P: 1 %; MI: 33 %; p<0.001), 3rd and 4th (P: 0 %; MI: 58 %; p<0.001), 5th (P: 0 %; MI: 56 %; p<0.001). Conclusion The percentages of inappropriate admissions to obstetric units confirm the underlying trend of inappropriate access to care. The prevalence of inappropriate days of stay in the Minor Islands Group showed an inadequate assistance for the complexity of the cases, thus causing inappropriateness. A solution to this could be found in the development, integration and implementation of territorial and district services, to which low complexity cases could be redirected for assistance.