A Questionnaire Integrated with the Digital Medical Record Improved the Coverage of a Control Program for Congenital Chagas Disease in Tuscany, Italy.

The leading route of Chagas disease transmission in nonendemic countries is congenital. However, policies concerning screening, prevention, and management of congenital Chagas disease are rare in these settings. Since 2012, serological screening for Chagas disease should be provided for pregnant women at risk in Tuscany, Italy according to a Regional resolution. Due to difficulties in the implementation, in November 2019, a checklist aimed at identifying pregnant women at risk for Chagas disease was introduced in digital clinical records at Careggi University Hospital, Florence, Italy. In order to evaluate the effectiveness of the "Chagas checklist", data about the number of deliveries by women at risk and their screening coverage between 2012 and June 2022 were collected. Out of 1348 deliveries by women at risk, 626 (47%) Trypanosoma cruzi serology tests were performed during the study period. The annual screening coverage increased from an average of 40.3% between 2012 and 2019 to 75.7% between 2020 and June 2022, underlining the big impact of the checklist. Four Chagas disease serological tests out of 626 (0.6%) resulted positive, corresponding to 2 affected women. No cases of congenital transmission occurred. The study showed that a simple digital tool led to a tangible improvement in the coverage of the screening program; its application in a setting where digital charts are available will contribute to the control and elimination of congenital Chagas disease.

Careggi Re-Engineered Discharge project: standardize discharge and improve care coordination between healthcare professionals.

BACKGROUND: The hospital discharge process plays a key role in patient care. Careggi Re-Engineered Discharge (CaRED) aimed at establishing a meaningful relationship among general practitioners (GPs) and patients, throughout the discharge process. OBJECTIVE: The aim is to describe the activities and results in the period 2014-17 of the CaRED. METHODS: CaRED is a restructured discharge protocol, which foresees a different, more direct form of communication between hospital and GPs, enabled by an ad hoc electronic medical record. The 30-day hospital readmission rate and/or accesses to the emergency department were evaluated as proxy for effective communication. A pre-post survey was launched to assess the GPs' perceived quality, and patient and family satisfaction. RESULTS: A total of 1549 hospitalizations were included, respectively, 717 in the pre and 832 in the post-intervention period. The 30-day hospital readmission rate decreased significantly in the post-intervention period (14.4% vs. 19.4%, χ2(1) = 8.03, P < 0.05).Eighty-two and 52 GPs participated, respectively, in the pre- and post-survey. In the post-phase the percentage of GPs declaring the discharge letter facilitated the communication on the admission causes (χ2(1) = 0.56, P = 0.03) and on what to do if conditions change (χ2(31) = 19.0, P < 0.01) significantly increased, as well as the perception of an easier contact with the hospitalist (χ2(3) = 19.6, P < 0.01).Two-hundred-eighty and 282 patients were enrolled in the pre- and post-survey. The level of understanding of key parts of the discharge letter (reason for hospitalization, post-discharge therapy, follow-up examinations and how to contact the hospital ward) improved significantly (P < 0.01). CONCLUSIONS: CaRED significantly improved the discharge process and became a benchmark for local improvements in communication patterns with GPs.

Early discharge criteria in patients with acute bacterial skin and skin structure infections in a large tertiary-care teaching hospital in Florence, Italy.

The study is aimed at retrospectively estimating the percentage of inpatients with severe acute bacterial skin and skin structure infections (ABSSSI) who met the early discharged (ED) criteria adapted from Nathwani et al. (Int J Antimicrob Agents. 2016 Aug;48(2):127-36) and to calculate the number of hospitalization days that could be potentially saved. A retrospective study was conducted in a tertiary care hospital in Florence, Italy. We included all patients admitted for cellulitis and post-surgical infections from 2014 to 2017. Demographic and clinical data were obtained from electronic medical records. We a priori defined the following as a risk factor for non-adherence (RFNA): active or on methadone intravenous drug users, homeless, migrants without health care assistance, and patients who need a caregiver to take prescribed medications. One hundred sixty-two subjects were enrolled. Of them, 94 (58.0%) were male, and 113 (69.7%) had cellulitis/erysipelas. A microbiological isolate was obtained in 51 patients (31.4%); Staphylococcus aureus was the most frequent (47%). Eighty-four (51.8%) were ED suitable, with 258 (49.0%) patient days potentially saved. Among the 78 not ED suitable patients, the most common reason for prolonged length of stay (LOS) was having at least one RFNA (34.6%). Fourteen (18.0%) had one RFNA. Half of the patients admitted in our hospital met the ED criteria with a sparing close to 50% in terms of hospitalization days. Unstable social and personal factors were the most frequent causes for prolonged LOS. In this selected subset of patients, more recent and easier to administer treatments, including long-acting agents, could be proposed.

[Acute intoxications and poisonings in Italian Emergency Rooms]. / Intossicazioni acute e avvelenamenti nei Dipartimenti di Emergenza e Urgenza in Italia.

The analysis of 2402 prospective records of subjects consecutively attending eleven Emergency Rooms located in Northern, Central and Southern Italy, during the November 2002-May 2003 period, because of acute intoxication and poisoning (AI), shows that 10 admissions per 1000 are due to AI, accounting at national level for over 240,000 yearly admissions. Six AI of ten are caused by alcohol, alone or in combination with drugs and other poisonings, 2 by drugs and 2 by other types of AI. AI are more frequent among males (65%) and 20-40 ages. AI due to alcohol and drugs are more typical of young males, living in Central and Northern Italy, while those due to medicines are proportionally more represented among females of Southern Italy.