[Study on the immediate care clinics of the Internal Medicine Department (University Clinic Hospital of Valladolid)]. / Evaluación de las consultas de atención inmediata en Medicina Interna (Hospital Clínico Universitario de Valladolid).

BACKGROUND: Several studies have found a high percentage of inadequate admissions to Internal Medicine Departments. In order to try to alleviate this situation, the Immediate Care Clinics of the Internal Medicine Department (ICCIMD) was created, to study those patients who are suspected of having a serious disease, and whose physical condition allows them to undergo an out-patient study the day after having visited the Emergency Department. The tests requested will take precedence over the rest of the consultations. METHODS: Descriptive, retrospective study, through the review of the clinical records of the patients who came to the ICCIMD during the first two years. RESULTS: Our service admitted 726 people in the ACCIMD, 52.2 % males, average age of 54.12 years old. A total of 18.6 % of the patients required hospital admission; this admission being carried out at the first medical examination in 66.7% of the cases. In most cases, it can be related with shortening a study that would have lasted longer. In spite of this, we consider that 1.4 daily admissions have been avoided. Mean time devoted to this study was about 33.20 days, much greater than that expected, because of the high prevalence of non-specific disease and hospital organization deficit. It was decided to study 76.6% of the patients sent, their diagnosis being achieved in 63.3% of the total number of patients. Nevertheless, the ICCIMD was inadequate, as hospital admission was required or the patient was sent to other specialities in the 27.3% of the cases. CONCLUSIONS: We think that the ACCIMD can be useful to improve efficiency of Internal Medicine Department, although, to do so, the significant problems found must be solved.

Evaluación de las consultas de atención inmediata en Medicina Interna (Hospital Clínico Universitario de Valladolid) / Study on the inmediate care clinics of the Internal Medicine Department (Universitary Clinic Hospital of Valladolid)

Introducción. Diversos estudios han encontrado un alto porcentaje de ingresos inadecuados en los servicios de Medicina Interna. Para paliar esta situación se creó la Consulta de Atención Inmediata en Medicina Interna (CAIMI), en la que se estudia a pacientes con sospecha de patología grave, pero que su estado físico les permita un estudio ambulatorio al día siguiente de haber ido a Urgencias. Las pruebas solicitadas tendrían prioridad sobre las del resto de consultas. Métodos. Estudio descriptivo, retrospectivo, mediante la revisión de las historias clínicas de los pacientes atendidos en la CAIMI durante los dos primeros años. Resultados. Nuestro servicio atendió en la CAIMI a 726 personas (el 52,2% varones) con una edad media de 54,12 años. El 18,6% de los pacientes atendidos precisó el ingreso; el 66,7% de ellos desde la primera consulta. En la mayoría de los casos parece relacionarse con el hecho de acortar un estudio que se prevé largo. A pesar de ello estimamos que se han evitado 1,4 ingresos al día. El tiempo medio de estudio empleado fue de 33,20 días, muy superior al esperado, debido a la alta prevalencia de patología inespecífica valorada y déficit de organización hospitalaria. Se decidió estudiar al 76,6% de los pacientes enviados, lográndose el diagnóstico en el 63,3% del total de pacientes. Sin embargo, la CAIMI fue insuficiente al precisar el ingreso o la derivación a otras especialidades en el 27,3% de los casos. Conclusiones. Creemos que la CAIMI puede ser útil para mejorar la eficiencia de los servicios de Medicina Interna, aunque para ello es necesario solucionar los importantes déficit encontrados

Background. Several studies have found a high percentage of inadequate admissions to Internal Medicine Departments. In order to try to alleviate this situation, the Immediate Care Clinics of the Internal Medicine Department (ICCIMD) was created, to study those patients who are suspected of having a serious disease, and whose physical condition allows them to undergo an out-patient study the day after having visited the Emergency Department. The tests requested will take precedence over the rest of the consultations. Methods. Descriptive, retrospective study, through the review of the clinical records of the patients who came to the ICCIMD during the first two years. Results. Our service admitted 726 people in the ACCIMD, 52.2 % males, average age of 54.12 years old. A total of 18.6 % of the patients required hospital admission; this admission being carried out at the first medical examination in 66.7% of the cases. In most cases, it can be related with shortening a study that would have lasted longer. In spite of this, we consider that 1.4 daily admissions have been avoided. Mean time devoted to this study was about 33.20 days, much greater than that expected, because of the high prevalence of non-specific disease and hospital organization deficit. It was decided to study 76.6% of the patients sent, their diagnosis being achieved in 63.3% of the total number of patients. Nevertheless, the ICCIMD was inadequate, as hospital admission was required or the patient was sent to other specialities in the 27.3% of the cases. Conclusions. We think that the ACCIMD can be useful to improve efficiency of Internal Medicine Department, although, to do so, the significant problems found must be solved