Area of admission and short-term care: an integral part of the internal medicine ward organized to intensive care

Introduction
The analysis of the production related to health care activities in the Medicine ward of dell'Angelo Hospital (Mestre-Venezia, Italy) in the year 2010 reveals that the short-term hospitalization, less than 3 days, corresponds to 18% of all inpatient admissions.

Objectives
The short-term hospitalization approach need to be governed, both in terms of effectiveness and efficiency. In our department we have identified an area called Admission and Short Stay Area, where the discharge follows a comprehensive diagnostic and therapeutic pathway. Accordingly, we plan to extend the number of beds dedicated to the short stay in hospital, in order to decrease the average duration of stay avoiding the risk of increasing the readmissions, to share new pathways between health care workers.

Materials and methods
Within the department we have identified 8 beds for patients admitted from the emergency room. In the same beds triage is performed. In these beds the maximum duration of stay is 3 days. To achieve this goal we used clinical pathways shared between health workers, and bedside diagnostic procedures such as ultrasounds.

Results
In 2011 than to year 2010 there was an increased rate of short-term hospitalization (22-18%). Despite that the mean hospital stay was unchanged (10.3-10.6 days). The number of readmission within 90 days was also unchanged when we considered the most common diseases. More than 90% of health care workers followed the pre-established clinical care pathways.

Conclusions
The presence of a small number of beds within the medicine ward was dedicated to perform triage that allows to identify clinical care the needs of the patient. Among these some can be resolved in 3 days, rewarding patients and saving human and financial resources. To achieve this goal it is necessary that health care providers share clinical pathways, and that the bedside ultrasound is accessible.