Ceriani Elisa, Milani Olivia, Donadoni Mattia, Benetti Alberto, Berra Sergio Antonio, Canetta Ciro, Colombo Fabrizio, Dentali Francesco, Magnani Luigi, Mazzone Antonino, Montano Nicola, Muiesan Maria Lorenza, Podda Gian Marco, Querini Patrizia Rovere, Squizzato Alessandro, Casazza Giovanni, Cogliati Chiara
Internal Medicine Department, Ospedale Luigi Sacco, ASST Fatebenefratelli-Sacco, Milan, Italy.
Internal medicine Department, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
Intern Emerg Med. 2025 Mar;20(2):471-479. doi: 10.1007/s11739-024-03823-0. Epub 2024 Dec 10.
The ongoing demographic, epidemiological and social changes are dramatically raising the clinical and care complexity of patients admitted to internal medicine (IM) departments. Collecting evidence for a better characterization of patients is crucial to tailor future interventions based on patient's real needs. The aim of this prospective multicenter study was to describe the complexity of care of patients hospitalized in IM by calculating the complexity of care (ICC) score, through the combination of clinical instability (NEWS score) and care dependency scales (mICD). Furthermore, social frailty was assessed according to potential difficulty in discharge planning. 3912 patients were enrolled (median age 78 years); 71% had a Charlson Comorbidity Index ≥ 5. The ICC score was high in 14.7% of patients, while 15% exhibited a NEWS score at least moderate. One in four patients presented moderate to critical social frailty. The length of stay was correlated with social frailty, mICD and ICC scores, but not with NEWS. In-hospital mortality was correlated with the severity of all the considered scores. A relevant proportion of IM patients exhibited a high complexity of care. Our data support a model in which approximately 15% of IM beds are designated for clinically unstable patients managed in intermediate care sub-units. The substantial burden of social frailty highlights the urgency of national plans allowing at the same time to cover the needs of not self-sufficient and socially disadvantaged patients, and to efficiently address the issue of emergency department boarding.
当前的人口、流行病学和社会变革正在显著增加内科住院患者的临床和护理复杂性。收集证据以更好地描述患者特征对于根据患者实际需求制定未来干预措施至关重要。这项前瞻性多中心研究的目的是通过结合临床不稳定性（NEWS评分）和护理依赖量表（mICD）计算护理复杂性（ICC）评分，来描述内科住院患者的护理复杂性。此外，根据出院计划的潜在困难评估社会脆弱性。共纳入3912例患者（中位年龄78岁）；71%的患者Charlson合并症指数≥5。14.7%的患者ICC评分较高，而15%的患者NEWS评分至少为中度。四分之一的患者存在中度至重度社会脆弱性。住院时间与社会脆弱性、mICD和ICC评分相关，但与NEWS评分无关。院内死亡率与所有考虑评分的严重程度相关。相当一部分内科患者表现出高度的护理复杂性。我们的数据支持一种模式，即约15%的内科床位指定用于在中级护理亚单元管理的临床不稳定患者。社会脆弱性的沉重负担凸显了国家计划的紧迫性，这些计划应同时满足不能自理和社会弱势患者의需求，并有效解决急诊科滞留问题。
