Scant justification for interhospital transfers: A cause of reduced efficiency in the emergency department

INTRODUCTION: Interhospital transfers are one of the critical points of the emergency system, which often cause overcrowding of the emergency department (ED) and limit its effectiveness. METHODS: A retrospective study was carried out, analyzing the clinical case files concerning the ED of the Policlinico "Umberto I" in Rome (Latium region, Italy) with the aim of establishing the reasons for the numerous unjustified transfers. RESULTS: From 1 January to 30 June 2006, 77 597 admissions to the ED occurred, and 861 patients (1.1%) were sent from other hospitals. 361 patients out of 861 (41.9%) were transferred with critical clinical conditions. The remaining 500 patients (58.1%) were transferred requiring specialised care. The need for specialised care was confirmed in 230 cases (46.0%) and therefore these transfers could be considered justified. The other 270 transfers (54.0%) were unjustified: 138 patients remained in the hospital to which they had been sent, contributing to crowding of the ED; 132 patients were returned, thereby placing them at additional risk. CONCLUSION: Unfamiliarity with the regulations governing interhospital transfers is the main cause of scantly justified transfers and the consequent reduction in efficiency of the ED in the receiving hospital

Malnutrition in elderly patient: case report

An 83-year old woman was admitted to our hospital following the onset of asthenia and anorexia from approximately the last 20 days. Blood chemistry analysis and physical examination showed a condition of protein-calorie malnutrition. During the clinical course the patient showed markedly depressed mood and refusing food orally. Was set, therefore, a treatment with olanzapine and parenteral nutrition followed, after 14 days of treatment, a high-calorie diet supplemented with dietary supplements

Self-administrated test based on the Marigliano-Cacciafesta Polypathological Scale (MCPS), as a screening tool for early identification of frailty in the elderly: A cohort study

The aim of our study was to screen people of advanced age for "frailty", and illnesses, in order to prevent future disabilities through interventions made globally and individually to these patients. Applying the items such as those of the Marigliano-Cacciafesta Polypathological Scale (MCPS), we utilized a completely multi-dimensional evaluation. We have elaborated a series of simple and comprehensive questions enabling all participants to answer independently and easily. The results of the testing were successful. Within their limits, all the participants considered the test as a valuable instrument to assess their weaknesses. The test was especially efficient when it came to identifying problem areas in the psycho-physical state and frailty of elderly patients, as well as some loss of their own autonomy. These studies successfully tested a cohort of elderly people with similar symptoms