Census of Ligurian Internal Medicine Wards of non-teaching hospitals

Abstract

Medicine advances are associated with an increasing life expectancy that means also an increasing preva-lence of chronic diseases (heart failure, chronic obstructive pulmonary disease, diabetes, hypertension, overweight and obesity, oncological or neurodegenerative diseases, etc.). Not seldom, multiple chronic disorders are variously associated in the same patient and influence each other, leading to complex picture. Their management is the core competency of Internal Medicine. 1 Today, Hospital Internal Medicine plays an irreplaceable role in small and large hospitals, representing the natural place of care for several patients and admitting patients (>80%) from Emergency Room or from other wards mainly as urgent cases. 2 An emerging model suggests for IMWs an organization based on intensity of care, 3 with areas differentiated according to patients health needs. In the higher level, a team of physicians and nurses can assist patients who require mechanical ventilation and/or affected by stroke, acute pulmonary oedema, acute renal failure, metabolic decompensation, stratified on arrival by in-hospital mortality predictive scores, such as modified early warning score (MEWS) or Vital-pac™ early warning score (ViEWS). 4,5 Once more, in chronic patients, the limit between inpatient and outpatient medicine is gradually disappearing, and internal medicine is the classical link discipline. 6 Primary care and internal medicine physicians must work in a continuum of care.Unfortunately, continuous cuts of hospital beds without parallel development of alternative care pathways out of hospital affected Italian National Health

Performance management of generalist care for hospitalised multimorbid patients—a scoping review for value-based care

“…There were 2 publications that aimed to describe the activities and characteristics of a group of internal medicine wards across hospitals, and this involved some outcome measures ( 24 , 35 ).…”

“…One study noted that university hospital internal medicine wards were mostly sub-specialised, with programmed admissions not from the emergency room. Hence, they were excluded as benchmarking would have been inconsistent ( 24 ).…”

A model to improve the appropriateness in the management of acute poly-pathological patients: the acute complex care model

“…7 Ability to perform some procedures, like abdominal paracentesis, arterial line placement, advanced cardiac life support, central venous line placement, lumbar puncture, nasogastric intubation, thoracentesis 6 and intercostal drain insertion, direct current cardioversion, urethral catheterization, temporary cardiac pacing, 7 bed-side ultrasonography and non-invasive mechanical ventilation, are strongly recommended for ACCM internists.…”

“…The essential activities and attributes of IMWs are: 5,6 i) diagnosis and management of complex, polypathological, and frail patients; ii) provision of basic technological care and filter for sub-specialized and highly technological care; iii) high functional flexibility from outpatients clinic and hospice to critical or sub-intensive care; iv) specialized care in internal medicine sub-categories; v) multi-professional coordination; vi) co-management of surgical patients by different models, before and after surgery.…”