Tzong-Luen Wang, MD, PhD; Hang Chang, MD, PhD

Abstract -- To understand the appropriateness of hospitalization and its possible impact on bed utilization when disasters occur, we studies the bed utilization of 7 tertiary medical centers in Taipei by applying the Appropriateness Evaluation Protocol (AEP). The study period was from July 2004 to December 2004. The average hospitalization days of the seven tertiary medical centers were 10.2+3.4 days. There were no statistically significant differences in hospitalization days among these hospitals (9.7+2.8 days vs. 11.5+3.7 days, P=NS). Average patient-hospitalization days of the seven tertiary medical care centers were 14,325+2,109 per month. The average bed occupation rate was 88+6%. Twenty-nine of all admissions and 18% of consecutive hospital days were judged as inappropriate. Age, gender, and hospital length of stay was not associated with the proportion of inappropriate hospital days. The highest rates of inappropriate care were among the very elderly, among patients with hospital stays > 4 weeks, and acute medical causes. At present, HRC of the seven tertiary medical centers in Taipei was about 1.5+0.5%. Because of the inappropriate admission and hospitalization rate being 29%, the bed occupation rate can be adjusted to be 66+8%. The total saturation time can increase from 4 hours to 11 hours (P<0.05) if HRC was 1.5%, or 8 hours if HRC was 2%. In conclusion, this study demonstrated that there is still a significant portion of inappropriate hospitalization in Taipei even under the strict policies of National Health Insurance. Under the estimated HRC of 1.5%, the saturation time can be increased significantly after adjusting the observed inappropriateness of admission.