Hospitals and organizational models based on the intensity of treatment: the internist's point of view

Introduction

The type of patients being treated in our hospitals has changed significantly. Today's patients are much older with more complicated, polypathological problems. As a result, hospital organization and management structures must also change, particularly in Internal Medicine. A widely discussed approach, organization according to intensity of treatment, could be an appropriate solution from an organizational viewpoint that would also satisfy these new demands.

Materials and methods

With the aid of a questionnaire sent to internists working in the hospitals of Italy's Emilia-Romagna region and the review of the relevant medical literature, we defined structural, organizational, technological, managerial, and staffing characteristics to better determine and classify this model. We analyzed questionnaire responses of 31 internists heading operative units in their hospitals, a relatively homogeneous subgroup with experience in organizing and managing healthcare as well as its clinical aspects.

Results

Analysis of these questionnaires revealed important points concerning the model: 1) an accurate identification of the medical care on which to base the model; 2) a well-defined strategy for differentiated allocation of staff to structural and technological areas depending on the level of medical care provided in the area; 3) an accurate definition of the types and features of patients targeted by each level of medical care; 4) an early exchange (starting from the patient's arrival in the Emergency Department) of information and medical knowledge among Emergency Department physicians and those present during the initial stages of hospitalization; 5) a precise definition of responsibilities in the different areas, operative and collaborative stages among different physicians and medical staff, the different disciplines involved in the process.

Conclusions

Among the physicians responsible for managing complex areas of Internal Medicine in Emilia-Romagna hospitals, organization of medical care on the basis of treatment intensity is generally considered the model most likely to meet the demands of the patients being treated in our hospitals. However, application of this model requires a well-defined organizational method. Levels of medical care and organizational instruments need to be precisely defined within this method. Simple differentiated organization of nursing care is clearly no substitute for an organizational model of this kind.