Porta Giovanni, Signorini Fabiola, Converso Marcella, Cavalot Giulia, Caramello Valeria, Rossi Carlotta, Aprà Franco, Beltrame Angela, Boccuzzi Adriana, Boverio Riccardo, Calci Mario, Castaldo Ersilia, Covella Michele, Cuppini Patrizia, Ghilardi Giulia Irene, Mirante Enrico, Noto Paola, Pierpaoli Lucia, Parpaglia Paolo Pinna, Ricchiardi Alberto, Zanetti Michele, Zatelli Daniela, Nattino Giovanni, Bertolini Guido
Department of Emergency Medicine, Santa Maria Delle Grazie Hospital, Pozzuoli, Naples, Italy.
Department of Medical Epidemiology, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, 24020, Ranica, Bergamo, Italy.
Intern Emerg Med. 2025 Jan;20(1):257-266. doi: 10.1007/s11739-024-03640-5. Epub 2024 May 18.
High-Dependency care Units (HDUs) have been introduced worldwide as intermediate wards between Intensive Care Units (ICUs) and general wards. Performing a comparative assessment of the quality of care in HDU is challenging because there are no uniform standards and heterogeneity among centers is wide. The Fenice network promoted a prospective cohort study to assess the quality of care provided by HDUs in Italy. This work aims at describing the structural characteristics and admitted patients of Italian HDUs. All Italian HDUs affiliated to emergency departments were eligible to participate in the study. Participating centers reported detailed structural information and prospectively collected data on all admitted adult patients. Patients' data are presented overall and analyzed to evaluate the heterogeneity across the participating centers. A total of 12 HDUs participated in the study and enrolled 3670 patients. Patients were aged 68 years on average, had multiple comorbidities and were on major chronic therapies. Several admitted patients had at least one organ failure (39%). Mortality in HDU was 8.4%, raising to 16.6% in hospital. While most patients were transferred to general wards, a small proportion required ICU transfer (3.9%) and a large group was discharged directly home from the HDU (31%). The expertise of HDUs in managing complex and fragile patients is supported by both the available equipment and the characteristics of admitted patients. The limited proportion of patients transferred to ICUs supports the hypothesis of preventing of ICU admissions. The heterogeneity of HDU admissions requires further research to define meaningful patients' outcomes to be used by quality-of-care assessment programs.
作为重症监护病房（ICU）和普通病房之间的中间病房，高依赖护理单元（HDU）已在全球范围内得到应用。对HDU的护理质量进行比较评估具有挑战性，因为没有统一的标准，且各中心之间的异质性很大。Fenice网络推动了一项前瞻性队列研究，以评估意大利HDU提供的护理质量。这项工作旨在描述意大利HDU的结构特征和收治的患者情况。所有隶属于急诊科的意大利HDU均有资格参与该研究。参与研究的中心报告了详细的结构信息，并前瞻性地收集了所有收治成年患者的数据。总体呈现患者数据并进行分析，以评估各参与中心之间的异质性。共有12个HDU参与了该研究，纳入了3670名患者。患者平均年龄为68岁，有多种合并症且正在接受主要的慢性治疗。若干收治患者至少有一个器官功能衰竭（39%）。HDU的死亡率为8.4%，住院死亡率升至16.6%。虽然大多数患者被转至普通病房，但一小部分患者需要转至ICU（3.9%），还有一大部分患者直接从HDU出院回家（31%）。HDU在管理复杂和脆弱患者方面的专业能力得到了现有设备和收治患者特征的支持。转至ICU的患者比例有限支持了预防ICU收治的假设。HDU收治情况的异质性需要进一步研究，以确定护理质量评估项目可使用的有意义的患者预后指标。
