Can Clinical Governance tools improve the appropriateness in hospital stay?

Background Low rates in the application of organizational appropriateness (OA), ranging in Europe from 14 to 30% in medical wards, represent a threat on proper use of resources within the best health outcomes. At the same time, Clinical Governance (CG) provides a framework for bringing together all local activities for assessing and improving clinical quality into a single coherent program. The purpose of this study was to verify possible correlations between implementation level of CG areas and OA of hospital stay, as measured within a large Teaching Hospital. Methods The study was conducted between July and December 2012 in a Italian third level Teaching Hospital to have a simultaneous representation of CG implementation and OA within hospital wards. The CG level was assessed through the OPTIGOV© methodology, that is a CG scorecard aimed at investigating the main CG dimensions (Evidence Based Medicine (EBM), Accountability, Clinical Audit, Resources and Risk Management, Patient Involvement) by assigning each of them a score. OA was measured by analyzing 1460 random medical records through the Italian version of the Appropriateness Evaluation Protocol (PRUO 2002ed). Spearman correlation and multiple linear regression were used to test the relationship between the percentage of inappropriate days of hospital stay and CG scores. Results 46 Units were assessed. The percentage of inappropriate days of hospital stay showed an inverse correlation with all the main CG dimensions, except Risk Management. The strongest correlation was found with EBM (rho=0.32, p<0.05). The multiple regression analysis adjusted for type of hospital ward (surgical/medical) and admission (elective/urgent) showed a significant association between the percentage of inappropriate days and the overall CG score (β= -.005; p = 0.03; R-squared = 0.20) and the EBM score (β= -.006; p = 0.01; R-squared = 0.32). Conclusions This study underlines the importance of the evaluation, through standardized and repeatable tools, such as OPTIGOV and AEP, of both CG and OA. Furthermore the relationship between them underline the central role of CG, and especially of EBM, for the improvement of OA. Key message Combining CG and OA and addressing their common determinants is a winning strategy for improvement.