The Appropriateness Evaluation Protocol is a poor predictor of in-hospital mortality.

BACKGROUND: The Appropriateness Evaluation Protocol (AEP) proposes admission criteria based only on physiological and laboratory parameters and has recently informed an Irish national bed utilisation review. Severity of illness tools can be poorly predictive of outcomes, particularly in older patients. AIMS: To assess the clinical utility of the AEP in moribund older and younger patients. METHODS: The study was conducted in four acute hospitals in South Munster, Ireland, and was of retrospective analytical cohort study design. The Hospital In-Patient Enquiry Scheme was used to ascertain patients who died within 10 days of hospital admission, over a 2-year period. Proximate death was used as a robust measure of validity of admission. Emergency department (ED) records were screened retrospectively to allocate the AEP criteria. RESULTS: There were 803 eligible in-hospital deaths. Establishment of AEP criteria was available in 72.9 % (585 patients, 50.8 % female). The median length of stay until death was 4 days. Just over 30 % (179/585) of patients did not meet AEP criteria, two-fifths (72/179) of whom had been coded as severely unwell on arrival to the ED. There was no significant difference in AEP identification rates between older and younger age groups. CONCLUSIONS: Our study illustrates that the AEP is a poor predictor of mortality in all age groups, having failed to identify approximately one-third of our cohort. Based on our findings, we feel that this tool should not be used to assess the appropriateness of admission.

A profile of hospital consultants: the health practices of a cohort of medical professionals.

Personal health practices are important determinants of health. Smoking habits are well documented among doctors. However, alcohol consumption, exercise rates and obesity rates are not. No indigenous studies have been done in this area. This descriptive population study aims to determine these factors. A questionnaire was sent to 381 consultants in hospitals affiliated with UCC Medical School. The response rate was 52.5% (200/381). The smoking rate was 7.5% (15/200) and the alcohol consumption rate was 94% (188/200). Both were more prevalent in females. Over a fifth took no exercise and activity levels were similar between groups. Female consultants were better at weight management than males with a lower proportion over the healthy body mass index (BMI) level. The smoking rate and alcohol consumption rate is higher than other studies. When compared to the general population, doctors are a healthier weight and smoke less but more consultants drink and less exercise regularly.