Triulzi M, Costantino D, Auxilia F, Fabiani P, Ottone M
Ann Ig. 1989 Jan-Apr;1(1-2):255-65.
The general lack of nurses and the attention due to the purposes of efficiency, effectiveness and economy of hospital services oblige to better the cooperation between attending and family physicians, to improve the resources, the productiveness of clinicopathology, the use of daily hospital services (such as ambulatories, daily hospitalization and treatments) and emergencies. For this end the authors propose the realization of a day hospital which mainly aim is the diagnostic (D.H.D.) of internal medicine. The admission will be acted by a doctor of the emergency department and of the reception. The day hospital will be functionally linked up with the services of emergency dpt. and reception and with the outpatients' department. Therefore useful both for the attending and family physicians. This kind of day hospital shouldn't substitute the specialities (such as hematology, oncology, psychiatry, dialysis, rehabilitation, etc.) which finalities are principally the therapy and check-up of known patients who follow a treatment by a specialistic department. The D.H.D. should grant the following functions: --Diagnosis or provable orientation in case the doctor of the emergency dpt. or the specialist in ambulatory shouldn't be able to perform them immediately; --Clinical control of cases coming from the emergency dpt.; --Planning of therapeutic program and carrying out of ambulatory therapies that cannot be deferred, of cases coming from the emergency dpt. or reception. Then, is attributable to the D.H.D. the hospital statistics that: --requires clinical observation that cannot be deferred; --requires unerring, prompt and complex diagnostic orientation in order to decide the kind of ward where the hospitalization should be done; --if needed, hospital therapeutic intervention that cannot be deferred, incompatible with the operative possibilities of the D.H.D. The authors also deal with operative relations between D.H.D. and other hospital services, the staff organization, the location, dimension and functional attribution of the head office, the purchases and availability of sanitary fittings and furnishings. Finally, the authors estimate the effectiveness of D.H.D. as far as the reduction of continuative hospitalization is concerned.
护士普遍短缺，出于医院服务效率、效果和经济性的考虑，必须加强主治医生和家庭医生之间的合作，改善资源、临床病理学的生产力、日常医院服务（如门诊、日间住院和治疗）以及急诊服务的利用情况。为此，作者提议设立一家日间医院，其主要目标是进行内科诊断（D.H.D.）。入院将由急诊科医生和接待处医生负责。日间医院将在功能上与急诊科、接待处以及门诊部的服务相联系。因此，这对主治医生和家庭医生都很有用。这种日间医院不应替代那些主要负责对由专科部门进行治疗的已知患者进行治疗和检查的专科（如血液学、肿瘤学、精神病学、透析、康复等）。D.H.D.应具备以下功能：——在急诊科医生或门诊专科医生无法立即进行诊断的情况下，进行诊断或提供可证实的诊断方向；——对来自急诊科的病例进行临床监测；——为来自急诊科或接待处的病例制定治疗方案并实施不能推迟的门诊治疗。那么，以下医院统计数据应归因于D.H.D.：——需要不能推迟的临床观察；——需要准确、迅速且复杂的诊断方向，以便决定患者应住院的病房类型；——如有需要，进行不能推迟的医院治疗干预，但这与D.H.D.的手术可能性不兼容。作者还讨论了D.H.D.与其他医院服务之间的业务关系、人员组织、总部的位置、规模和功能分配、卫生设备和家具的采购及供应情况。最后，作者评估了D.H.D.在减少持续住院方面的有效性。
