Internal medicine and emergency admissions: From a national hospital discharge records (SDO) study to a regional analysis

Abstract

In Italy, the number of internists has grown by 10% since 1990 reaching 11,435 units, they manage 39,000 beds in 1060 Internal Medicine (IM) wards. The Internists are expected to ensure a cost-effective management of poly-pathological and complex patients. A collaborative study between the Federation of Associations of Hospital Doctors on Internal Medicine (FADOI) and the Consortium for Applied Health Economics Research (C.R.E.A. Sanitá) based on data from hospital discharge records has been conducted starting from November 2014. In this article the preliminary results are shown with focus on emergency admissions characteristics to contribute to define the role of hospital IM. Evaluation is performed comparing emergency and planned admissions, IM impact on hospital admissions, availability of community-based healthcare services, diagnosis-related groups (DRGs) weight in IM and regional differences in managing hospital admissions with focus on IM department. In 2013 IM wards discharged 1,073,526 patients (16.18% of the total discharged by hospitals) with a total economic value of 3,426,279.88 € (average DRG 3882.80 €, from 3682.19 to 4083.42). The average length of stay (LOS) in IM was 9.3 days. IM covers 27% of admissions from Emergency Room. Determinants significantly affecting the emergency admissions are old age and comorbidities of the patients that also have a role in increasing LOS. 55% of Italian hospital admissions are emergency admissions. Hospitalization rates in emergency are systematically higher than those in election and the greatest differences are in the regions with inefficiently organized regional network. The role of the hospital IM appears central in the offer of beds to the emergency room by accepting 27% of urgent admissions. The increasing impact of IM on hospital management will put the internists as authoritative stakeholders in health policy.