Ospedali e modelli organizzativi per intensità di cure: il punto di vista dell’internista

Chesi, Giuseppe; Boni, Fabrizio

doi:10.1016/j.itjm.2011.04.008

Cited by 9 publications

(11 citation statements)

References 7 publications

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“…Recent articles, 18 referring to IMWs, highlighted this issue and defined structural, organizational, technological, managerial, and staff-related characteristics to better determine and classify the intensity of treatment organization. To implement this organization the following actions are crucial: i) accurate identification of the medical care levels; ii) differentiated staff and technological equipment according to the level of medical care provided; iii) admission criteria for each level of medical care; iv) strict interaction between Internal Medicine Department, Emergency Department and Specialties; v) integration of different competencies.…”

Section: How Acute Complex Care Model Can Actualize Hospitals and Orgmentioning

confidence: 99%

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

Orlandini¹,

Pietrantonio²,

Moriconi

et al. 2016

Ital J Med

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Improved care for acute diseases has increased mean age and the proportion of people affected by multiple chronic diseases, while mutated socioeconomic conditions augmented the number of elderly and socially frail subjects. Multi-morbid patients who require a global approach not fragmented care interventions and a close connection between health and social services are progressively growing. Acute complex care model (ACCM) is a model of integrated management of the frail patients when they need of acute hospital care. The name of our model - ACCM - just recalls the Chronic Care Model (CCM), designed for the dehospitalization of chronic patients by preventing acute exacerbations, representing the hospital counterpart of the CCM. The target population are acutely ill complex and polypathological patients (AICPPs), admitted to hospital and requiring high technological resources and continuous monitoring; the mission is improving the management of medical admissions through pre-defined intra-hospital tracks and a global, multidisciplinary, patientcentred approach. Nowadays, multiple uncoordinated specialists care for AICPPs who move from one ward to another, with dangerous loss of information and continuity. ACCM tries to overcome these problems by putting the internal medicine specialist as the only referent for that patient and the coordinator of the care team. According to a model of future hospital organized with different intensity settings, the Internal Medicine Wards (IMWs), caring for AICPPS, are organized in High Dependency Areas and Ordinary Areas. For both we present organizational and personnel standards that are lacking in daily practice. The epidemiological transition leading to a progressive increase in AICPPs requiring frequent hospitalization enhances the role of hospital internal medicine specialist in the coordination and delivery of care. The ACCM represents a practical response to this epochal change of roles. Medical and nursing staff standards and competencies has to be reviewed to ensure adequate care for these patients.

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Section: How Acute Complex Care Model Can Actualize Hospitals and Orgmentioning

confidence: 99%

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

Orlandini¹,

Pietrantonio²,

Moriconi

et al. 2016

Ital J Med

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“…Heart failure Acute coronary syndromes or threatening cardiac rhythm or conduction disorders not to be exhaustive for defining the patient clinical status, 15 we suggest to add to it the presence or suspect of one of the listed clinical conditions that, when present, by itself make necessary a medical higher care area, until clinical stabilization. In other words, any of the listed conditions overwhelm the numeric score and should be considered in the proposed evaluation form.…”

Section: Shock Of Various Etiologiesmentioning

confidence: 99%

The change of hospital internal medicine: a study on patients admitted in internal medicine wards of 8 hospitals of the Lazio area, Italy

et al. 2015

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The hospital internal medicine (IM) needs to adapt to the socio-demographic changes occurred during the last thirty years: patients currently show an increased overall complexity owing to the increase in the average age of the patients admitted, to more several and severe comorbidities, and a higher concentration in our wards of most severe cases. Our departments have to change in order to pursue a more efficient organization and to offer care to users modulated according to their needs and conditions. The Intensity of Care in Internal Medicine Group of the Federation of Associations of Hospital Doctors on Internal Medicine - Lazio carried out a population-based study in eight Internal Medicine wards of the region with the aim of characterizing the patients there admitted, using the modified early warning score (mEWS), monitoring and evaluating the outcomes of hospitalization. This has allowed us to determine the cut-off of the score indicating a greater statistical probability of a fatal outcome corresponding to 3, contrary to what originally reported by Subbe <em>et al.</em> in 2001. According to our results into the Departments of IM should be provided an area of high care, where monitor and stabilize the patients admitted with a mEWS score ≥3, before transferring them to the wards of lower intensity of care. This organizational model of the high care of medical patients has the benefit of offer the technical and professional assistance appropriate to the level of clinical risk, with more intensive care to more critical stages of illness.

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“…Negli ultimi anni si è affermata l'esigenza di istituire un'area con simili funzioni anche nell'ambito dei reparti di Medicina Interna. In alcune Unità Operative è ormai consolidato il modello per intensità di cure, in grado di individuare e di offrire ai pazienti la necessaria terapia-assistenza, influendo così anche sulla durata della degenza [4]. La prima nozione di area di degenza breve proviene dall'esperienza americana degli ''hospitalists'', i medici ospedalieri.…”

Section: Pazienti Eleggibili Pazienti Non Eleggibiliunclassified

Area of admission and short-term care: an integral part of the internal medicine ward organized to intensive care

Serafini¹,

Bonanni²,

Zancanaro³

et al. 2012

Ital J Med

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Introduction The analysis of the production related to health care activities in the Medicine ward of dell’Angelo Hospital (Mestre-Venezia, Italy) in the year 2010 reveals that the short-term hospitalization, less than 3 days, corresponds to 18% of all inpatient admissions.Objectives The short-term hospitalization approach need to be “governed”, both in terms of effectiveness and efficiency. In our department we have identified an area called “Admission and Short Stay Area”, where the discharge follows a comprehensive diagnostic and therapeutic pathway. Accordingly, we plan to extend the number of beds dedicated to the short stay in hospital, in order to decrease the average duration of stay avoiding the risk of increasing the readmissions, to share new pathways between health care workers.Materials and methods Within the department we have identified 8 beds for patients admitted from the emergency room. In the same beds triage is performed. In these beds the maximum duration of stay is 3 days. To achieve this goal we used clinical pathways shared between health workers, and bedside diagnostic procedures such as ultrasounds.Results In 2011 than to year 2010 there was an increased rate of short-term hospitalization (22–18%). Despite that the mean hospital stay was unchanged (10.3–10.6 days). The number of readmission within 90 days was also unchanged when we considered the most common diseases. More than 90% of health care workers followed the pre-established clinical care pathways.Conclusions The presence of a small number of beds within the medicine ward was dedicated to perform triage that allows to identify clinical care the needs of the patient. Among these some can be resolved in 3 days, rewarding patients and saving human and financial resources. To achieve this goal it is necessary that health care providers share clinical pathways, and that the bedside ultrasound is accessible.

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Ospedali e modelli organizzativi per intensità di cure: il punto di vista dell’internista

Cited by 9 publications

References 7 publications

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

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

The change of hospital internal medicine: a study on patients admitted in internal medicine wards of 8 hospitals of the Lazio area, Italy

Area of admission and short-term care: an integral part of the internal medicine ward organized to intensive care

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