Hospitalisation process seen by patients and health care professionals.

Appropriate use of hospitalisation is an important concern in most countries. Previous studies have relied on professional opinion regarding the appropriateness of hospital stays, neglecting the patients' point of view. The purpose of this cross-sectional study was to assess the patients' point of view about the appropriateness of their hospital stay and to evaluate agreement with health care providers' opinions. It was undertaken in a medical rehabilitation division of the University Hospitals of Geneva in Switzerland. Patients reported their opinion on the justification of their hospital stay on the day of the interview, the reason why they judged their stay to be appropriate, and the place where they should be if not. The patients' health care providers answered the same questions. Two-hundred and fifty-four patients contributed to the evaluation of 314 days of hospitalisation. Only 20 hospital days (6%) were considered unjustified by patients, compared to 63 (20%) by health care providers (p<0.001). There was no agreement between these two judgements (Kappa=0.00,95% CI: -0.09 to +0.09). Similarly, there was little or no agreement concerning the reasons justifying the stay (Kappa=0-0.47) and concerning discharge planning. These results suggest that the definition of an appropriate hospital stay is complex and depends upon each actor's point of view. Better communication between patients and health care providers about decisions related to the hospitalisation process would be desirable.