Is this admission really relevant?

Acutely admitted medical patients often present with a complex medical history. Patients admitted through an acute medical admission unit (AMAU) has had symptoms for an unknown period of time before contacting a general practitioner or the emergency room. The history will vary from acute onset to more chronic illness with acute worsening or lack of response to a given treatment. In AMAUs with limited beds and a large number of acute admissions daily we often witness disagreement between general practitioners, doctors and nurses whether or not the patient at hand has to be acutely admitted or even admitted at all. We therefore conducted a questionnaire study including doctors and nurses at an AMAU to investigate how often the two groups disagree on the necessity of an acute admission.

During the period of 22th of July and the 8th of August we asked nurses and doctors, admitting patients through an AMAU, whether or not they found the acute admissions relevant. The data was analysed using the Fleiss Kappa Coefficient Analysis and are presented descriptively.

We received 138 answers from doctors and 213 from nurses, and have questionnaires regarding 67 patients where both the doctors and nurses had answered. Out of the 67 cases both groups found 17 of the admissions to be irrelevant. Using the Fleiss Kappa Analysis we find a κ value of 0.369. In 51 cases the nurses and doctors agreed whether or not the patient should or should not be admitted acutely, leaving the doctors and nurses in disagreement in 16 (23.9%) cases.

The doctors and nurses in our study often agree on whether or not a patient should or should not be admitted acutely. The Fleiss kappa analysis gave a fair agreement, when compared with Landis and Koch interoperation scale. In almost one in four cases the nurses and doctors have different opinions on whether or not the patient should be admitted acutely. The consequences of this, for the patients, would be purely theoretic in this presentation, seeing that we have not investigated any patient outcome regarding morbidity or mortality.