RT Journal Article
SR Electronic
T1 Potentially avoidable admissions to general internal medicine at an academic teaching hospital: an observational study
JF CMAJ Open
JO CMAJ
FD Canadian Medical Association
SP E201
OP E207
DO 10.9778/cmajo.20220020
VO 11
IS 1
A1 Alex M. Cressman
A1 Ushma Purohit
A1 Ellen Shadowitz
A1 Edward Etchells
A1 Adina Weinerman
A1 Darren Gerson
A1 Kaveh G. Shojania
A1 Lynfa Stroud
A1 Brian M. Wong
A1 Steve Shadowitz
YR 2023
UL http://www.cmajopen.ca/content/11/1/E201.abstract
AB Background: Identifying potentially avoidable admissions to Canadian hospitals is an important health system goal. With general internal medicine (GIM) accounting for 40% of hospital admissions, we sought to develop a method to identify potentially avoidable admissions and characterize patient, provider and health system factors.Methods: We conducted an observational study of GIM admissions at our institution from August 2019 to February 2020. We defined potentially avoidable admissions as admissions that could be managed in an appropriate and safe manner in the emergency department or ambulatory setting and asked staff physicians to screen admissions daily and flag candidates as potentially avoidable admissions. For each candidate, we prepared a case review and debriefed with members of the admitting team. We then reviewed each candidate with our research team, assigned an avoidability score (1 [low] to 4 [high]) and identified contributing factors for those with scores of 3 or more.Results: We screened 601 total admissions and staff physicians flagged 117 (19.5%) of these as candidate potential avoidable admissions. Consensus review identified 67 candidates as potentially avoidable admissions (11.1%, 95% confidence interval 8.8%–13.9%); these patients were younger (mean age 65 yr v. 72 yr), had fewer comorbidities (Canadian Institute for Health Information Case Mix Group+ 0.42 v. 1.14), had lower resource-intensity weighting scores (0.72 v. 1.50) and shorter hospital lengths of stay (29 h v. 105 h) (p < 0.01). Common factors included diagnostic and therapeutic uncertainty, perceived need for short-term monitoring, government directive of a 4-hour limit for admission decision-making and subspecialist request to admit.Interpretation: Our prospective method of screening, flagging and case review showed that 1 in 9 GIM admissions were potentially avoidable. Other institutions could consider adapting this methodology to ascertain their rate of potentially avoidable admissions and to understand contributing factors to inform improvement endeavours.