Sammanfattning
BACKGROUND: The objective of this study was to identify the basis for admission to a large medical department in Norway. We have assessed possible alternatives to hospitalisation and whether triage may help identify relevant patients.
MATERIAL AND METHOD: All admissions to Drammen Hospital over a full week in the autumn of 2014 were recorded with the patient’s age, gender, hospitalisation period, referring doctor/institution, from where the patient was admitted and his/her diagnosis at admission and discharge. Alternatives to hospitalisation, in light of the condition upon departure from the primary health services, were systematically evaluated by two general practitioners and an experienced doctor at the medical department through a review of the referral notes. The patients were triaged in the emergency reception immediately after arrival, and the degree of seriousness of their condition was assessed against possible alternatives to hospitalisation.
RESULTS: The study included 255 admissions (52 % women, average age 62 years). In 57 % of the cases, the referring doctor was from the primary health service (GP 26 %, out-of-hours doctor 31 %) and in 24 % from the specialist health services. Altogether 18 % of the cases were admitted with no direct referral from a doctor. The most frequent diagnoses for admission included cardiovascular disease (38 %), pulmonary disorders (11 %) and infections (9 %). For 7 % of the patients who had been admitted by a primary doctor we found possible alternatives to hospitalisation, mostly admission to a municipal intermediate care unit. There was no correlation between triage and alternatives to hospitalisation.
INTERPRETATION: The proportion of admissions from general practitioners was higher than that found by equivalent studies. One in every 15 admissions (7 %) was deemed relevant for alternative solutions. Triage does not identify patient pathways that are suitable for alternatives to hospitalisation.