Patients 21 days or more in an acute hospital bed: appropriateness of care.

Patients occupying beds for 21 days or more in acute hospitals were studied. Using predetermined objective criteria, the appropriateness of the previous day's hospitalisation was assessed. Barriers to appropriate care and the level of care required were identified in those deemed inappropriate. Of the 421 patients identified, 194 were considered to be inappropriately placed in an acute hospital bed. Patients deemed inappropriate were more likely to be older (p less than 0.05), female (p less than 0.05), have lost a spouse (p less than 0.05), have been admitted through the Accident and Emergency Department (p less than 0.05), and have longer lengths of stay (p less than 0.001) than those considered appropriate. The most frequently identified barrier to appropriate care (N = 143) was that the patient was awaiting another level of care. The level of inappropriate use of acute beds in Dublin is unacceptably high. Additional longstay accommodation especially for geriatric patients is needed. Alternatives to acute hospital care for patients requiring rehabilitation or nursing care should be explored.