L’organizzazione ospedaliera per intensità di cure: revisione sistematica della letteratura

[Autom. eng. transl.] INTRODUCTION: The hospital for intensive care (OIC) is an organizational model structured in areas dedicated to patients with homogeneous care needs. The objective of the present study was to carry out a systematic review of the literature on the level of medium-intensity care for the OIC medical area by identifying the existing organizational models, the results of the application in Italy and analyzing the performance / efficacy / efficiency, the strengths and weaknesses of the model. MATERIALS AND METHODS: The systematic review was conducted on Pubmed and Cinhal databases and on Google and Google Scholar search engines. The research was limited to studies in English and Italian and no time limit was applied. RESULTS: 10 articles were included in the review. Two English studies have shown an improvement in nursing care and a reduction in the average stay after the activation of the program for treatment intensity. An American study showed an improvement in quality indicators and doctor-nurse communication, a reduction in costs and tensions between staff. An Italian study has photographed the state of the art in Italy: the structures that have started or planned a reorganization of the OIC are mainly concentrated in Emilia Romagna, Tuscany and Lombardy and in about half of the cases the change has affected only some areas. The results of three Italian case studies that documented a reduction in the average stay and the turnover index, an increase in the employment rate and the average weight of the DRG were also reported. Finally, among the strengths of the model, an improvement in the perception of nursing care by the patient was identified while health workers expressed, as critical, the increased transfer of patients, the lack of collaboration between professional figures and uncertainty about responsibilities. CONCLUSIONS: The OIC model adopted in Italy, similar to the US one, has found different applications in regional realities. Although these applications did not provide for the realization of all levels of assistance intensity, an improvement in the indicators was highlighted.