1. THE PROSPECTIVE VERSION OF THE
APPROPRIATENESS EVALUATION
PROTOCOL (AEP) IN PORTUGAL:
OUR FIRST EXPERIENCE
Javier R. Vera, Nuno Vieira, Luisa Arez, Rui Tomé
Department of Internal Medicine. Sector I.
Hospital do Barlavento Algarvio
Portimão. Portugal. EU

2. INTRODUCTION
Appropriateness Evaluation Protocol (AEP).
-Developed on the ´80s to evaluate the overuse of
hospital beds.
-60 objective criteria. Classify as appropriate or
inappropriate the admission and stay.
-Appropriateness=1 criterion

3. Modalities of AEP (I)
Depending on the kind of Dependending on the
study: speciality:
-Prospective -Medical Protocol
-Concurrent -Surgical Protocol
-Retrospective -Pediatric Protocol

4. Modalities of AEP (II)
Complemented AEP :
1. Demographic parameters (age, gender)
2. Clinical parameters (multiadmission,
mortality, comorbidity-Charlson)
3. Appropriateness AEP
4. Management parameters: Average stay,
admission during the weekend, length of time from the
admission to the Emergency Department until the
admission to the Department of Internal Medicine

5. APROPRIATENESS EVALUATION PROTOCOL
Utility
• Numeric data.
Makes possible comparing the efficiency of hospitals
with similar characteristics.
B) Causes of appropriateness/inappropriateness.
Strategies to decrease inappropriateness

6. OBJECTIVE
Studying on Medicine I:
1. Inappropriateness of admissions
2. Causes of appropriateness/inappropriateness

7. MATERIAL AND METHOD (I)
Kind of study:
Systematic randomized prospective study
Inclusion criterion:
Patients admitted on beds 9, 22, 23, 24 of Sector I
of the Department of Medicine during 2003.
Exclusion criterion:
Patients moved from other beds of the Department.

8. MATERIAL AND METHOD (II)
Tool of assessment:
Prospective medical complemented version of the AEP:
1. Demographic parameters (age, gender)
2. Clinical parameters (multiadmssion, mortality,
comorbidity-Charlson)
3. Appropriateness AEP
4. Management data: average stay, admission
during the weekend, time from the admission to
the emergency department to the admission to
the Department of Internal Medicine

9. MATERIAL AND METHOD
(III)
Statistical analysis:
Access database
Average, CI
Χ2, T Student
SPSS for Windows

10. RESULTS (I)
N= 175
Average age: 72,37 yrs (SD 14,42)
67,4% male; 32,6% female
Multiadmission: 33,1%
Charlson Index: Average 3,83. 49%>=4
Mortality 11,4% (Sector Average 12,3%)

11. RESULTS (II)
Appropriateness AEP
17,7% inappropriate admissions
-diagnostic tests or therapies that could have
been done as outpatient
-Need admission, but not in an acute care hospital
83,3% appropriate admissions
-29,2% => 2 appropriateness criteria

12. RESULTS (III)
Reasons for appropriateness
140
96,5%
120
100
80
60
40
20 9,72%
6,94%
0
Inv Tech
IV Med
IM Ab
Alts elect
motor Def
Act Hem
Brad/taqu
Alts cons

13. RESULTADOS (IV)
Management parameters
Average stay: 8,44 days (Sector average 9,89)
Admissions during the weekend:
-N= 17 (9,7%)
-Average stay: 13,29 dias (vs 7,92 in admissions
Mon-Fry)
-Mortality= 0

14. RESULTS (V)
Management paramenters
Procedence of the patients
outpatients Other Dpts
5%
1%
Emergency
94%

15. RESULTS (VI)
Management parameters
Time from the admission to the hospital until the admission in Medicine I
35,00%
30,00%
25,00%
20,00%
15,00%
10,00%
5,00%
0,00%
<24h 24-48h 48-72h >72h

16. CONCLUSIONS (I)
1.The inappropriateness of the admissions was 17,7%,
result similar to those of other studies carried out in
the Iberian Peninsula.
2. The most common criterion for appropriateness was
utilization of intravenous therapy. A careful
consideration of the need of parenteral medication
might eventually make the patients tributary of other
level of care than an acute care Hospital.

17. CONCLUSIONS (II)
3. The longer stay of the people admitted during the
weekend might be due to the inexistence of elective
medical care during that period. A specific program of
assistance to the ward on weekends might improve
this parameter.