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

Appropriateness is one of the main topics of health policyand should be estimable in order to analyze the efficacy ofhospital services. The Review and Use of the HospitalProtocol (in Italian: Protocollo di Revisione dell’Uso dell’Ospedale-PRUO) allowed us to evaluate the appropriatenessof hospitalizations, starting from daily available clinical recordsin a selected hospital.Methods The cross-sectional study applied the PRUOmethodon a sample of medical records (N=575; years: 2008–2010)related to ordinary admissions to obstetric wards of Lipari andPantelleria Hospital (both Minor Islands of Sicily: MI) and tothe Teaching Hospital of the University of Palermo (P) inorder to evaluate the incidence of appropriateness and to highlightthe main factors related to inappropriateness.Results Statistical analysis showed a similar prevalence ofinappropriate admissions in both groups (2–3 %). Significantdifferenceswere found in the prevalence of inappropriate daysof 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 toobstetric units confirm the underlying trend of inappropriateaccess to care. The prevalence of inappropriate days of stay inthe Minor Islands Group showed an inadequate assistance forthe complexity of the cases, thus causing inappropriateness. Asolution to this could be found in the development, integrationand implementation of territorial and district services, towhich low complexity cases could be redirected forassistance.