Jiménez Alvarez C, Morales Torres J L, Ruiz Montes A M, Pérez Sáez F, Navarro Espigares J L
Hospital Universitario Virgen de las Nieves, Granada.
Cir Pediatr. 1999 Jan;12(1):11-5.
There is wide-spread consensus that a part of the use of hospital resources is inadequate in the sense that the patients receive services that do not provide them with any significant benefits, or that could be more beneficial, or less costly, with a lower care standard.
The main aim of this work is to determine the percentage of inadequate stays in a pediatric surgery service and to identify the causes that provoke them.
It was a concurrent study in pediatric patients entered, at least 24 hours, by different disease for surgery, observation or study. Revising trained applied the pediatric version of the Appropriateness Evaluation Protocol on the medical records of these patients. It has been measured if the stay was appropriated or not, and the cause.
The studied patients (279) caused a total of 1,001 stays of those which 373 (37.3%) were deemed to be unnecessary. The diseases with greater number of inappropriate stays were cryptorchidia (97.3%), hernia (88.9%), hypertrophic pyloric stenosis (50%), and soft tissues surgery (43.1%). A 68.2% of the unnecessary stays were responsibility of the hospital-service-surgeon, a 22.6% to the associated environment-familiar, and a 9.2% to the lack of alternative resources to the hospital.
A meaningful proportion by day of hospital stay would be avoided. The unnecessary stays search facilitates the weak points identification on those which to develop improvement actions.
人们普遍认为，部分医院资源的使用存在不足，因为患者接受的服务并不能为他们带来任何显著益处，或者这些服务在较低护理标准下可能更有益或成本更低。
这项工作的主要目的是确定小儿外科服务中住院时间不合理的比例，并找出导致这种情况的原因。
这是一项针对因不同疾病入院至少24小时进行手术、观察或研究的儿科患者的同期研究。经过培训的审核人员对这些患者的病历应用儿科版的适宜性评估方案。评估住院时间是否合理以及原因。
所研究的患者（279名）共产生1001次住院，其中373次（37.3%）被认为是不必要的。住院时间不合理次数较多的疾病有隐睾症（97.3%）、疝气（88.9%）、肥厚性幽门狭窄（50%）和软组织手术（43.1%）。68.2%的不必要住院是医院 - 科室 - 外科医生的责任，22.6%是相关环境 - 家属的责任，9.2%是医院缺乏替代资源的责任。
可以避免相当一部分住院天数。对不必要住院情况的排查有助于找出需要改进的薄弱环节。
