My 4th Congress, during the first year of trainee of INternal Medicine, with a 2-4 posters and 2 oral communications presebted. Then, I am sent to Portugal, famous for it Excellent Physicians and paradigm of a well designed Health System (from Spain, namely Southern Andalusia). I tried my best to demonstrate our neighbours, we were not a bunch of redneck. And I thing I suceed. Not being aware of that, I had give my first step towards working&living in Portugal

1. APPROPRIATENESS OF THE
ADMISSIONS IN AN INTERNAL
MEDICINE WARD
ALCOUCER DÍAZ MR, RODRIGUEZ-VERA FJ,
RODRÍGUEZ GÓMEZ FJ, MARTINEZ GARCIA T,
COLCHERO FERNANDEZ J, PUJOL DE LA LLAVE E.
INTERNAL MEDICINE DEPT. HOSPITAL JUAN RAMON JIMENEZ

2. OBJECTIVE
Evaluating the
appropriateness of the
admissions in an Internal
Medicine Ward by using
the AEP
INTERNAL MEDICINE DEPT. HOSPITAL JUAN RAMON JIMENEZ

3. MATERIAL AND METHOD (I)
s Retrospective review of 201 Clinical
Reports of patients admitted in our
ward during the first three months of
1997.
s AEP is used to evaluate the adecuacy.
s The admission is considered to be
Appropriate if at least one of the
criteria is acomplished.
INTERNAL MEDICINE DEPT. HOSPITAL JUAN RAMON JIMENE

4. MATERIAL AND METHOD (II)
s Variables analized:
-Epidemiological: Age and Gender.
-Clinical: Pathology that causes the
admission .
s -Management: Average stay and
number of admissions.
s Statistic analysis with SPSS package using
Chi 2 and t Student. DEPT.
INTERNAL MEDICINE HOSPITAL JUAN RAMON JIMENE

5. RESULTS (I)
s Appropriate admissions: 86.5%
s Innapropriate admissions:13.4% Appropiate
100 Inappropiate
s 92.5% were urgent and 7.5%
programmed
50
s The most frequent criteria:
– need for iv medication or fluid
replacement.
0
– Need for respiratory care.
– Monitoring of vital signs at
least every two hours.
INTERNAL MEDICINE DEPT. HOSPITAL JUAN RAMON JIMENE

6. RESULTS (II)
number of criteria
30
1 Criteria
25
(19.9%)
20 2 Criteria
15 (25.9%)
3 Criteria
10 (22.4%)
5 4 Criteria
(13.9%)
0 5 Criteria or
more (4.5%)
INTERNAL MEDICINE DEPT. HOSPITAL JUAN RAMON JIMENE

7. RESULTS (III)
PATHOLOGY THAT CAUSES THE
ADMISSION
Appropiate admissions Inappropiate admissions
Cardiovascular Poorly defined
Infectious Tumoral
Poorly defined 8 Infectious
100 Digestive Cardiovascular
Respiratory 6 Rheumatologic
80
Rheumatologic Haematologic
60 Endocrine 4 Endocrine
40
2
20
0
0
INTERNAL MEDICINE DEPT. HOSPITAL JUAN RAMON JIMENE

8. RESULTS (IV)
Management parameters
MOST FREQUENT CAUSES
MULTIADMISSION VS NON MULTIADMISSION OF INAPPROPRIATE
ADMISSION
*TO COMPLETE THE
STUDY :
s MULTIADMISSION: 66.7%
29.9% *UNKNOWN: 18.5%
*SOCIAL CAUSES: 14.8%
s NON MULTIADMISSION
*FAMILY INSISTENCE:0%
70.1% *IMPOSIBILITY OF
MOVING TO A CRONIC CARE
HOSPITAL:0%
INTERNAL MEDICINE DEPT. HOSPITAL JUAN RAMON JIMENE

9. RESULTS (V)
Management parameters
s Average stay: 10.58 +/- 7.38 days
s No difference has been found between
the average stay of appropriate and
inappropriate admissions.
s There is no difference in the
appropriateness respect the number of
admissions.
INTERNAL MEDICINE DEPT. HOSPITAL JUAN RAMON JIMENE

10. CONCLUSSIONS
s A 13.4% of the admissions in our Internal
Medicine Ward are Inappropriate. A
percentage could be avoided with a faster
ambulatory study.
s The most important pathologies which
causes admission are cardiovascular
diseases, infections, and poorly defined
pathology.
INTERNAL MEDICINE DEPT. HOSPITAL JUAN RAMON JIMENE