Effectiveness of a physician-oriented feedback intervention on inappropriate hospital stays.

OBJECTIVE To evaluate the effectiveness of a combined intervention to reduce inappropriate hospital stays. DESIGN Quasi-experimental pre-test/post-test with a non-equivalent control group. SETTING Three teaching hospitals in the National Health System in Alicante, Spain. STUDY PARTICIPANTS Intervention group (2 Surgical Units with 1451 hospital stays) and control group (1 Surgical Unit with 1268 hospital stays). INTERVENTION Structured oral presentation followed by direct feedback to surgeons about their own percentages of inappropriate stays and daily evaluation of appropriateness by the surgeons during their rounds. MAIN OUTCOME MEASURES Reduction in the percentage of inappropriate stays identified by the Appropriateness Evaluation Protocol during the intervention period compared to the basal period. RESULTS The intervention group reduced its percentage of inappropriate stays from 14.3% to 7.9% (absolute reduction: -6.40; 95% CI -10.7 to -2.14; relative reduction: 44.8%), while no changes occurred in the control group. The reduction was in the number of inappropriate stays attributable to the patients' medical management that went from 12.7% to 5.8% (absolute reduction: -6.92; 95% CI -10.90 to -2.92), while no significant changes occurred in inappropriate stays due to other causes. CONCLUSIONS A combined intervention of feedback and physician participation in appropriateness evaluations is effective in reducing the percentage of inappropriate hospital stays, particularly those attributable to conservative medical patterns at discharge.