Shiraz E-Med J. 2016 November; 17(11):e38677. Published online 2016 November 23. doi: 10.17795/semj38677. Research Article The Financial Burden of Inappropriate Admissions to Intensive Care Units of Shahid Faghihi and Nemazee Hospitals of Shiraz, Iran, 2014 Seyed Masoom Masoompour, 1 Mehrdad Askarian, 2 Maryam Najibi, 3 and Nahid Hatam 4,* 1 Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran 2 Professor, Department of Community Medicine, Shiraz Nephro- Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran 3 Students Research Committee, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran 4 Professor, Department of Health Service Administration, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran * Corresponding author: Nahid Hatam, Professor, Department of Health Service Administration, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran. Tel: +98-7132340871, Fax: +98-7132340039, E-mail: hatamn@sums.ac.ir Received 2016 May 20; Revised 2016 October 24; Accepted 2016 November 21. Abstract Background: Investigating the conditions and the appropriateness of admission of patients in hospitals is an important issue which can improve the efficiency of health care delivery. Intensive care unit (ICU) is important due to applying expensive financial sources; therefore, its efficient application is of great priority. In this regard, the current study aimed to determine the financial burden of inappropriate admissions in internal intensive care units (IICUs). Methods: It was a cross-sectional study conducted in 2014. A total of 294 patients admitted to IICUs of Shahid Faghihi and Ne- mazee hospitals of Shiraz, Iran, in 2012 were enrolled into this retrospective study. The study was conducted in two phases, using the guidelines of American critical care association (ACCA) and experts’ opinion to investigate the financial burden of inappropriate admissions in IICUs of the above-mentioned hospitals. Results: The results showed no statistically significant relationships among insurance status, insurance type, age, gender and in- appropriate admission by applying Chi-square. Among 294 admitted patients under the study, the inappropriate admissions were 11.2% based on the guidelines and 13.6% based on the experts’ opinion. The level of agreement of the guidelines and experts’ opinion for the inappropriate admissions was 0.076 based on Kappa coefficient. The total financial burden imposed on the insurance agen- cies and the patients by inappropriate admissions was US$ 47867.78 based on the guidelines and US$ 83241.68 based on the experts’ opinion. Conclusions: Inappropriate admissions to ICUs may impose additional costs to the health system and the patients on one hand, and deprives other patients from receiving health services. Therefore, it is crucial to effectively plan for the application of ICU beds. Keywords: Financial Burden, Inappropriate Admission, Intensive Care Unit 1. Background In recent years, health care development faced new obstacles due to the financial crisis (1). Special attention should be paid to evaluating the efficiency and appropri- ate application of the facilities in health care systems to achieve the highest efficiency (2, 3). Limiting the number of hospital beds, increasing the waiting list of medical cares, applying some solutions such as using the beds with the maximum efficiency and de- creasing the inappropriate admissions can lead to lower- ing the costs and also improving the quality and access in an effective way. Decreasing the inappropriate admissions can affect the quality of the healthcare services, improve the efficiency of the hospitals and decrease the waiting lists (4, 5). Unnecessary hospitalization increases the costs for the patients, reduces the available sources for critically ill pa- tients and increases the risk of nosocomial infections in the admitted patients as well (2). Hence, investigating the admission conditions in hospitals and its appropriateness is one of the important issues which can improve the effi- ciency of the hospitals. In previous research studies, appropriate admission was defined as the admission of the patients with no other choices except admitting them in hospital by considering this advanced level of the technology, and their admission is essential even by the existence of other choices with lower technology in the health system (6). In contrast to this definition, Soria-Aledo defined inappropriate admis- sions of the patients as an admission which could occur in a less complicated health center with lower costs (7). Among different hospital wards, intensive care unit (ICU) is of great importance due to its sophisticated equip- ment and expensive financial sources in a way that effi- cient application of the ward facilities is prior to saving these sources in possible cases (8). On the other hand, dif- ferent people are admitted in these wards. Moreover, the Copyright © 2016, Shiraz University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.