The Day Service as a model to reduce the inappropriateness of care: an Italian experience [Oral presentation]

Issue/problem Appropriateness of care is an important topic for European Public Health, particularly for countries with a National Health Service.In Italy, Lazio Region established the innovative organizational model of Day Service in order to promote appropriateness of care and defined it as an outpatient care modality, alternative to hospitalization and day hospital, aimed at treatment of patients with complex health problems but that usually do not require medical and nursing continuing surveillance. Description of the problem The Clinical Management Staff of the ‘‘Regina Elena’’ National Cancer Institute in Rome (Italy) established that the outpatient management of surgical patients in the hospital would occur by means of Day Service, through the delivery of packages of complex services identified at a regional level or through appropriate diagnostic-therapeutic pathways.Our objective was to describe the experience of the Day Service and compareresults between the last 4 months of 2013 and the first 4 months of 2014, using internal computerized databases. Results The introduction of Day Service has led to remarkable reductions in the number of inappropriate pre-admission tests, especially for the most expensive health services (-74.5% for Computerized Tomography,-93% for Magnetic Resonance Imaging,-61.9% for Positron emission scans and scintigraphy).The Day Service has also improved the overall patient experience, especially from an organizational point of view, and this is an important aspect, considering that most of the patients attending the ‘‘Regina Elena’’ Institute are affected by cancer, are often elderly and a considerable number of them reside outside Lazio Region. Lessons The implementation of Day Service in our experience showed to have a positive impact in terms of organization, reduction of hospital stay and overall hospitalization-related activities, and from an economic standpoint, with savings useful to improve patients’ care and facilities