Diagnostic pathways of the complex patients: rapid intensive observation in an Acute Medical Unit

Internal and Emergency Medicine

Volumn 6, Issue , 2011, Pages 85-92

  Realdi, Giuseppe ^a   Giannini, Sandro ^a   Fioretto, Paola ^a   Fabris, Fabrizio ^a   Vettore, Gianna ^b   Tosato, Franco ^b  

^a UNIVERSITY OF PADOVA   (Italy)

^b UNIVERSITY HOSPITAL OF PADOVA   (Italy)

Author keywords

Acute Medical Unit; Clinical complexity; Clinical reasoning; Decision making; Emergency department; Intermediate risk; Patient pathways; Rapid intensive observation

Indexed keywords

AGED; ARTICLE; CLINICAL PATHWAY; DECISION MAKING; EMERGENCY HEALTH SERVICE; HUMAN; INTERNAL MEDICINE; MIDDLE AGED; ORGANIZATION AND MANAGEMENT; THEORETICAL MODEL;

AGED; AGED, 80 AND OVER; CRITICAL PATHWAYS; DECISION MAKING; EMERGENCY SERVICE, HOSPITAL; HUMANS; INTERNAL MEDICINE; MIDDLE AGED; MODELS, THEORETICAL;

EID: 84857070305     PISSN: 18280447     EISSN: 19709366     Source Type: Journal    
DOI: 10.1007/s11739-011-0681-9     Document Type: Article

References (32)

1. Plsek PE, Greenhalgh T (2001) Complexity science: the challenge of complexity in health care. BMJ 323:625–628
2. Wilson T, Holt T, Greenhalgh T (2001) Complexity science: complexity and clinical care. BMJ 323:685–688
3. Morton AP (2011) Hospital safety and complexity. BMJ 342:514
4. Federoff HJ, Gostin LO (2009) Evolving from reductionism to holism: is there a future for systems medicine? JAMA 302(9):994–996
5. Mazzocchi F (2008) Complexity in biology. EMBO 9:10–14
6. Gore FM, Bloem PJN, Patton GC et al (2011) Global burden of disease in young people aged 10–24 years: a systematic analysis. Lancet 377:2093–2102
7. Diederichs C, Berger K, Bartels DB (2011) The measurement of multiple chronic disease. A systematic review on existing multimorbidity indices. J Gerontol A Biol Sci Med Sci 66(3):301–311
8. Centre for Clinical Practice at NICE (UK) (2007) Acutely Ill patients in hospital: Recognition of and response to acute illness in adults in hospital. London National Institute for Health and Clinical Excellence (UK) (http://www.nice.org.uk)
9. Royal College of Physicians (2007) Acute medical care. The right person, in the right setting—first time. Report of the acute medicine task force. London RCP
10. Guttman A, Schull MJ, Vermeulen MJ, Stukel TA (2011) Association between waiting times and short term mortality and hospital admission after departure from emergency department: population based cohort study from Ontario, Canada. BMJ 342:d2983
11. Walters EH, Dawson DJ (2009) Whole-of-hospital response to admission access block: the need for a clinical revolution. Med J Aust 191(10):561–563
12. Plsek PE, Wilson T (2001) Complexity, leadership, and management in healthcare organisations. BMJ 323:746–749
13. Scott I, Vaughan L, Bell D (2009) Effectiveness of acute medical units in hospitals: a systematic review. Int J Qual Health Care 21:397–407
14. Fatovich DM, Hughes G, McCarthy SM (2009) Access block: it’s all about available beds. Med J Aust 190(7):362–374
15. Mitra B, Cameron PA, De Villiers Smit P (2010) Whole-of-hospital response to admission access block: the need for a clinical revolution. Med J Aust 192(6):354–356
16. McNeill GBS, Brand C, Clark K et al (2011) Optimizing care for acute medical patients: the Australasian medical assessment unit survey. Intern Med J 41:19–26
17. Stott DJ, Langhorne P, Knight PV (2008) Multidisciplinary care for elderly people in the community. Lancet 371:699–700
18. Brillman J, Mathers-Dunbar L, Graff L et al (1995) Management of observation units. Ann Emerg Med 25:823–830
19. Hillman K (1999) The changing role of acute-care hospitals. Med J Aust 170:325–328
20. Epstein M, Barmania N, Robini J, Harbord M (2007) Reforming the acute phase of the inpatient journey. Clin Med 7(4):343–347
21. Nasraway SA, Cohen IL, Dennis RC et al (1998) Guidelines on admission and discharge for adult intermediate care units. Crit Care Med 26(3):607–610
22. Charlson ME, Sax FL (1988) Intermediate care. How do we know it works? Arch Intern Med 148:1270–1271
23. Jenkins PF, Barton LL, McNeill GBS (2010) Contrasts in acute medicine: a comparison of the British and Australian systems for managing emergency medical patients. Med J Aust 193(4):227–228
24. Franklin CM, Rackow EC, Mamdani B et al (1988) Decreases in mortality on a large urban medical service by facilitating access to critical care. Arch Intern Med 148:1403–1405
25. Hampton JR, Gray A (1998) The future of general medicine: lessons from an admissions ward. J R Coll Physicians Lond 32(1):39–43
26. Basic D, Khoo A (2009) Admission variables predicting short lengths of stay of acutely unwell older patients: relevance to emergency and medical short-stay units. Aust Health Rev 33(3):502–512
27. Bowen JL (2006) Educational strategies to promote clinical diagnostic reasoning. N Engl J Med 355:2217–2225
28. Heneghan C, Glasziou P, Thompson M et al (2004) Diagnostic strategies used in primary care. BMJ 338:b946
29. Realdi G, Previato L, Vitturi N (2008) Selection of diagnostic tests for clinical decision making and translation to a problem oriented medical record. Clin Chim Acta 393:37–43
30. Jones TR (2008) Approach to the emergency department patient. In: Stone CK, Humphries RL (eds) Current diagnosis and treatment: emergency medicine, 6th edn edn. McGraw-Hill, New York, pp 1–4
31. Roy PM, Colombet I, Durieux P et al (2005) Systematic review and meta-analysis of strategies for the diagnosis of suspected pulmonary embolism. BMJ 331:259–263
32. Ministero della Salute (2010) Documento commissione Urgenza-Emergenza. http://www.salute.gov.it/imgs/C_17_pubblicazioni_856_ulterioriallegati_ulterioreallegato_0_alleg.pdf