Hospital organization based on intensity of care: potential errors to avoid

IntroductionThe extreme variability of clinical severity in medical admitted patients is diluted in a “average” standard of care, that may be stronger than the real needs for someone, but clearly inadequate, sometimes even dangerous, for other ones, critically ill.DiscussionThe model of a differentiated intensity of hospital care can be defined as the organizational model structured to areas/sectors dedicated to patients with homogeneous needs of care. The intermediate care unit (“High dependency units”, “sub-intensive care areas” – “high care units”) are particularly suitable for patients who have a lower risk compared to patients treated in intensive care, but liable to develop complications and needing a close monitoring much more than the “standard”, “routine” care. The implementation of the a new organizational model must be careful and consider the possible enlargement errors that can be made. The analysis of the context is necessary for assess prerequisites, excluding the elements opposed to the success of the proposed model (i.e.: wards congestion and overcrowding, with a consequential with increased risk of adverse events). Before implementing and admitting patients in new “models”, we have to define the epidemiological population characteristics, their level of complexity/criticality/instability and the current assessment tools.ConclusionsAny new proposal of hospital management change has, as first obligation, to explicit the basic visions and primary goals for “the added value” resulting to the patient and the whole organization, with the evidence of an “health technology assessment” approach, for the professional hospital overall governance. But without the presumption, or worse, the apodictic assertion, to proclaim the implementation of structures with “differentiated intensity of hospital care” organizations that are not.</p

Aging, patient-bed management and overcrowding in the medical departments

BACKGROUND Hospital overcrowding (HO) profoundly affects the whole hospital system, reducing productivity and efficiency. The aging population and the increased prevalence of chronic-degenerative diseases, susceptible to acute exacerbations, make the elderly as frequent users of the emergency room (ER). There is a general agreement that the current disease-oriented and episodic model of care does not adequately cope with the complex needs of older patients. Hospital admission and discharge do not sufficiently link with primary care and other community resources, such as long-term care facilities and outpatient clinics. AIM OF THE STUDY To evaluate, using a simple dedicated software, the activity data of nine hospitals of Local Health Authority of Bologna (Italy) (ER accesses, hospital admissions, average length of stay – LOS) and the impact of a patient and bed management net in which managers, doctors and nurses share their operational skills to improve patient flow in medical and geriatric wards. RESULTS Data show that 24% ER accesses concern people &gt; 75 years old; 51% admissions concern people &gt; 75 years old; half of these admissions are from ER frequent users (FU = ≥ 3 ER accesses/ year). Only 15% admissions of younger people are from ER frequent users. Each of &gt; 75 years old frequent users produces an average of 2 admissions/year. At the end of the first year of this experience, ER accesses and admissions rose more than 8%. In our model of bed-management (patient and bed management net-software matching hospital capacity with admission, escalation measures) LOS was shortened by an average 0.5-1 day to a range from 0,5 to 1 day. DISCUSSION HO is due to mismanagement of chronic diseases (CD). Further actions are needed in primary health care to avoid unscheduled hospital due to CD. Applications for admission to hospital should be administered in the real context of the needs, developing both measures to face the contingent situation (setting temporary additional beds in one of the highest step of escalation measures) and post-discharge case management for selected “high risk-FU” patient profiles. CONCLUSIONS Our experience shows that an organizational model with a simple software is effective only to manage patient flow for relative small variations. Biggest peak of admissions requires strong link with primary care and other community resources, by systemic administration of health, particularly in frail people, with not scheduled hospital readmissions, for which hospital-centred care is not ever the best choice. Further research in initial ER assessment of FU is needed, by an identification of the high risk patient’s profile and its appropriate setting allocation

[Case report: the psychotic-mystical effects related to an unaware use of Salvia divinorum.]

It's well known that exotoxicosis can originate various psychiatric clinical pictures. The psychic impact of "classic" substances of abuse is well known and easily detectable with the usual methods of examination. In the last years new psychoactive substances (NPS) are spreading worldwide, determining not easily recognizable situations, with a significant clinical and organizational impact on psychiatry. In this case report, we present a clinical picture treated in hospital and outpatient settings in Vigevano (Pavia - Italy) and characterized by a psychotic onset secondary to an unaware use of Salvia divinorum. After the failure of two psychopharmacological treatment, the patient showed an excellent response to brexiprazole, with substantial restitutio ad integrum in the absence of significant side effects

Carotid lesions in outpatients with nonalcoholic fatty liver disease

AIM: To ascertain whether carotid lesions are more prevalent in outpatients with incidental findings of nonalcoholic fatty liver disease (NAFLD) at abdominal ultrasound (US)

Percutaneous real-time sonoelastography as a non-invasive tool for the characterization of solid focal liver lesions: A prospective study

Real-time sonoelastography is currently used for the characterization of superficial solid lesions such as thyroid and breast masses. This study evaluates the usefulness of percutaneous sonoelastography for the characterization of solid focal liver lesions