Filomena Pietrantonio1,2, Francesco Rosiello1,3, Elena Alessi1, Matteo Pascucci1, Marianna Rainone1, Enrica Cipriano1, Alessandra Di Berardino1, Antonio Vinci4, Matteo Ruggeri2,5, Serafino Ricci6. 1. Internal Medicine Unit, Castelli Hospital, Azienda Sanitaria Locale Roma 6, 00072 Ariccia, Italy. 2. Department of Health Economics, St. Camillus University Health and Medical Sciences, 00131 Rome, Italy. 3. Department of Public Health and Infectious Disease, Sapienza University of Rome, 00185 Rome, Italy. 4. School of Specialization in Hygiene and Preventive Medicine, University of Rome "Tor Vergata", 00133 Rome, Italy. 5. National Centre for HTA, National Institute for Health, 00161 Rome, Italy. 6. Department of Anatomical, Hystological Sciences and Legal Medicine, Sapienza University of Rome, 00185 Rome, Italy.
Abstract
Background: COVID-19 causes major changes in day-to-day hospital activity due to its epidemiological characteristics and the clinical challenges it poses, especially in internal medicine wards. Therefore, it is necessary to understand and manage all of the implicated factors in order to maintain a high standard of care, even in sub-par circumstances. Methods: This was a three-phase, mixed-design study. Initially, the Delphi method allowed us to analyze the causes of poor outcomes in a cohort of an aggregate of Italian COVID-19 wards via an Ishikawa diagram. Then, for each retrieved item, a score was assigned according to a pros/cons, opportunities/threats system. Scores were also assigned according to potential value/perceived risk. Finally, the performances of MCs (Medicine-COVID-19 wards) and MCFs (Medicine-COVID-19-free: Internal Medicine wards) units were represented via a Barber's nomogram. Results: MCFs hospitalized 790 patients (-23.90% compared to 2019 Internal Medicine admissions). The main risk factors for mortality were patients admitted from local facilities (+7%) and the presence of comorbidities (>3: 100%, ≥5: 24.7%). A total of 197 (25%) patients were treated with non-invasive ventilation (NIV). The most deaths (57.14%) occurred in patients admitted from local facilities. Conclusions: Medicine-COVID-19 wards show higher complexity and demand compared to non-COVID-19 ones and they are comparable to sub-intensive therapy wards. It is necessary to promote the use of NIV in such settings.
Background: COVID-19 causes major changes in day-to-day hospital activity due to its epidemiological characteristics and the clinical challenges it poses, especially in internal medicine wards. Therefore, it is necessary to understand and manage all of the implicated factors in order to maintain a high standard of care, even in sub-par circumstances. Methods: This was a three-phase, mixed-design study. Initially, the Delphi method allowed us to analyze the causes of poor outcomes in a cohort of an aggregate of Italian COVID-19 wards via an Ishikawa diagram. Then, for each retrieved item, a score was assigned according to a pros/cons, opportunities/threats system. Scores were also assigned according to potential value/perceived risk. Finally, the performances of MCs (Medicine-COVID-19 wards) and MCFs (Medicine-COVID-19-free: Internal Medicine wards) units were represented via a Barber's nomogram. Results: MCFs hospitalized 790 patients (-23.90% compared to 2019 Internal Medicine admissions). The main risk factors for mortality were patients admitted from local facilities (+7%) and the presence of comorbidities (>3: 100%, ≥5: 24.7%). A total of 197 (25%) patients were treated with non-invasive ventilation (NIV). The most deaths (57.14%) occurred in patients admitted from local facilities. Conclusions: Medicine-COVID-19 wards show higher complexity and demand compared to non-COVID-19 ones and they are comparable to sub-intensive therapy wards. It is necessary to promote the use of NIV in such settings.
Entities:
Keywords:
COVID-19; Internal Medicine ward; territorial medicine
Authors: Antonio Vinci; Amina Pasquarella; Maria Paola Corradi; Pelagia Chatzichristou; Gianluca D'Agostino; Stefania Iannazzo; Nicoletta Trani; Maria Annunziata Parafati; Leonardo Palombi; Domenico Antonio Ientile Journal: Int J Environ Res Public Health Date: 2022-05-13 Impact factor: 4.614
Authors: Zehra Onen-Dumlu; Alison L Harper; Paul G Forte; Anna L Powell; Martin Pitt; Christos Vasilakis; Richard M Wood Journal: PLoS One Date: 2022-06-07 Impact factor: 3.752