Design objectives:
(1) limited number of items, so easy for reviewer to learn and apply
(2) good inter-observer agreement
Items evaluated:
(1) medical services: 11 items
(2) nursing and ancillary services : 7 items
(3) patient's condition: 1 item occurring within 24 hours of the day reviewed, 7 items occurring within 48 hours of the day reviewed, and 1 item occurring within 14 days
Interpretation:
• A hospital admission was considered appropriate if one or more of the above criteria was present.
• A hospital admission was considered inappropriate if none of the above criteria were present.
• The evaluator may over-ride the criteria for either appropriate or inappropriate hospitalization.
Limitations:
• Health care has become more aggressive since the article was published. Several items listed above would now be considered appropriate for outpatient or home care.
• This should be viewed as a screen for possible inappropriate hospital care that is sensitive but which may not be specific. A case that fails to meet any of these criteria should be reviewed more closely for an explanation.
