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Variables determining clinical complexity in hospitalized Internal Medicine patients: a workload analysis

Valentina Tommasi, Alessandra Campolongo, Irene Caridi, Simone Gatti, Lorena Lagana, Ilaria Simonelli, Paola Piccolo, Dario Manfellotto
  • Valentina Tommasi
    Internal Medicine Unit, S. Giovanni Calibita, Fatebenefratelli Hospital; Fatebenefratelli Research Foundation for Healthcare and Social Education, Fatebenefratelli Hospital, Isola Tiberina, Roma, Italy | vxilit@tiscali.it
  • Alessandra Campolongo
    Fatebenefratelli Research Foundation for Healthcare and Social Education, Fatebenefratelli Hospital, Isola Tiberina, Roma, Italy
  • Irene Caridi
    Internal Medicine Unit, S. Giovanni Calibita, Fatebenefratelli Hospital, Isola Tiberina, Roma, Italy
  • Simone Gatti
    Internal Medicine Unit, S. Giovanni Calibita, Fatebenefratelli Hospital, Isola Tiberina, Roma, Italy
  • Lorena Lagana
    Fatebenefratelli Research Foundation for Healthcare and Social Education, Fatebenefratelli Hospital, Isola Tiberina, Roma, Italy
  • Ilaria Simonelli
    Fatebenefratelli Research Foundation for Healthcare and Social Education, Fatebenefratelli Hospital, Isola Tiberina, Roma, Italy
  • Paola Piccolo
    Internal Medicine Unit, S. Giovanni Calibita, Fatebenefratelli Hospital, Isola Tiberina, Roma, Italy
  • Dario Manfellotto
    Internal Medicine Unit, S. Giovanni Calibita, Fatebenefratelli Hospital; Fatebenefratelli Research Foundation for Healthcare and Social Education, Fatebenefratelli Hospital, Isola Tiberina, Roma, Italy

Abstract

The clinical complexity of Internal Medicine patients is a daily challenge for clinicians. Although clinical complexity cannot be directly measured, several scores describe the variability of clinical severity and comorbidity. The aim of this study was to analyze staff workload by assessing the nursing and medical complexity of patients admitted to an Internal Medicine ward. We included 40 consecutive inpatients [52.5% females, mean age 71.2 (18.2) years] classified according to the index of clinical complexity (ICC, type A: very high; type B: high; type C: moderate) and the cumulative illness rating scale (CIRS) severity and comorbidity index. Patient outcomes, hospitalization duration, tests performed, number of daily medications and time to perform standard nursing tasks were analysed across groups. Mean duration of hospitalization was 15.6 (10.1) days; in-hospital mortality was 15%. Mean CIRS severity index (SI) was 1.03 (0.31) and median CIRS comorbidity index (CI) was 2 (range 1-5). Significant differences were observed among ICC groups in time spent performing specific tasks [univariate analysis of variance F(2.37)=17.26, P<0.001]. No significant differences were found between the three groups for mean CIRS-SI [F(2.37)=3.033, P=0.060] and median CIRS-CI [Kruskal Wallis test: c2(2)= 1.672, P=0.433]. Clinical complexity and caring complexity were not correlated in our sample of Internal Medicine inpatients. Optimal care of Internal Medicine patients must take into account their complexity in both the medical and nursing aspects.

Keywords

Index of caring complexity; cumulative illness rating scale; nursing workload.

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Submitted: 2016-04-08 20:00:49
Published: 2017-06-14 12:04:07
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Copyright (c) 2017 Valentina Tommasi, Alessandra Campolongo, Irene Caridi, Simone Gatti, Lorena Lagana, Ilaria Simonelli, Paola Piccolo, Dario Manfellotto

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