Volume 11 - Issue 1

Opinion Biomedical Science and Research Biomedical Science and Research CC by Creative Commons, CC-BY

COVID-19 hospital admission appropriateness analysis

*Corresponding author: Abelardo Fernández Chávez, Preventive Medicine, Ramón y Cajal University Hospital, Preventive Medicine, M-607, km. 9, 100, 28034 Madrid, Spain.

Received: October 31, 2020; Published: December 03, 2020

DOI: 10.34297/AJBSR.2020.11.001599


Inconsistencies in clinical practice, coupled with uncertainty, are constants across all scenarios and throughout all time. In countries with better-developed healthcare models, overuse is far more problematic than underuse, hence the appearance of methods for assessing hospital inadequacy at the end of the 20th century [1]. During the COVID-19 pandemic, hospital admission criteria have been questioned based on the alleged inconsistency between hospitals [2,3]. Several studies put the proportion of inappropriate visits to hospital emergency services at between 20% and 80% of the total [4,5]. However, these studies date to the pre-SARS-CoV-2 pandemic period.


This study was to compare hospital admission criteria applied to COVID-19 patients in the emergency department of the Ramón y Cajal University Hospital (HURyC) and their alignment with the AEP (Appropriateness Evaluation Protocol) and PSI (Pneumonia Severity Index).


The HURyC is an extremely complex hospital with approximately 720 beds. Between 14 September and 5 October 2020, 501 patients diagnosed with SARS-CoV-2 were admitted to the hospital through the HURyC emergency department. We selected a random sample of 40 of these patients from a list of patients arranged in date order. The first patient was selected from the admissions on 14 September, and subsequent patients were selected at fixed intervals of 12 patients to a total of 40 patients.

The hospital admission criteria established in the emergency department of Hospital Ramón y Cajal (Table 1), the AEP and PSI scales were used [6,7] to meet the study objectives.

(Table 1).

Biomedical Science & Research

Table 1: COVID-19 hospital admission criteria used by the Ramón y Cajal Hospital.


All patients admitted to the hospital through the emergency department were hospitalised correctly according to the AEP scale, and 65% were hospitalised according to the HURyC admission criteria. If we add the patients hospitalised according to the hospital admission criteria with a SCORE equal to or greater than III on the PSI scale, the percentage of patients increases to 82.5%. Of these, 9.09% were non-mild infections (non-pneumonias); 60.61% were severe cases of pneumonia without ARDS; 9.10% had sepsis, and 21.21% were cases with PSI equal to or greater than III. A total of 17.5% of the patients did not fulfil the hospital admission or PSI criteria, and all these patients had mild pneumonia.

Discussion and conclusions

There is a need for a consensus on the hospital criteria to be adopted during the current COVID-19 pandemic. This study shows a total alignment between the hospital admissions and the MAP scale, i.e. there was no incongruency. Like the studies conducted during the pre-COVID-19 period, the MAP scale was closely aligned with appropriate hospital admission [2].

When the HURyC COVID-19 hospital admission criteria were applied, it was seen that 65% of hospitalisations were appropriate, but if we included patients with Score greater than or equal to III on the PSI scale, this percentage increased to 82.5%. The discrepancy between criteria may be explained by the fact that by assessing COVID-19 hospital admission criteria alone, other dependent nondiagnostic admission criteria were not considered. The AEP scale is for independent diagnosis.

The study was conducted during the second wave of increased incidence of SARS-CoV-2 cases in the Community of Madrid. It has been carried out scrupulously according to HURyC criteria for COVID-19 case. It is based on clinical data from the hospital’s electronic medical records. However, we have not considered other factors that influence the decision to hospitalise, such as social issues, hospital pressure, among others.