• Elisa Ceriani, Olivia Milani, Mattia Donadoni, Alberto Benetti, Sergio Antonio Berra, Ciro Canetta, Fabrizio Colombo, Francesco Dentali, Luigi Magnani, Antonino Mazzone, Nicola Montano, Maria Lorenza Muiesan, Gian Marco Podda, QueriniPatrizia RoverePRInternal Medicine Department, IRCCS Ospedale San Raffaele, Milan, Italy.Vita-Salute San Raffaele University, Milan, Italy., Alessandro Squizzato, Giovanni Casazza, Chiara Cogliati, and SIMI-FADOI Lombardy Network.
• Internal Medicine Department, Ospedale Luigi Sacco, ASST Fatebenefratelli-Sacco, Milan, Italy. elisa.ceriani@asst-fbf-sacco.it.
• Intern Emerg Med. 2024 Dec 10.

AbstractThe 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.© 2024. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).

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