The Function of Bed Management in Pandemic Times-A Case Study of Reaction Time and Bed Reconversion

The last decade was characterized by the reduction in hospital beds throughout Europe. When facing the COVID pandemic, this has been an issue of major importance as hospitals were seriously overloaded with an unexpected growth in demand. The dichotomy formed by the scarcity of beds and the need for acute care was handled by the Bed Management (BM) function. This case study explores how BM was able to help the solidness of the healthcare system, managing hospital beds at best and recruiting others in different settings as intermediate care in a large Local Health Authority (LHA) in central Italy. Administrative data show how the provision of appropriate care was achieved by recruiting approximately 500 beds belonging to private healthcare facilities affiliated with the regional healthcare system and exercising the best BM function. The ability of the system to absorb the extra demand caused by COVID was made possible by using intermediate care beds, which were allowed to stretch the logistic boundaries of the hospitals, and by the promptness of Bed Management in converting beds into COVID beds and reconverting them, and by the timely management of internal patient logistics, thus creating space according to the healthcare demands.

Second Victim Experience and Support Tool: An Assessment of Psychometric Properties of Italian Version

INTRODUCTION

Second victim syndrome is a hidden pitfall inside health care organizations. The impact of a patient safety incident on health and safety of health care workers (HCWs) is still a matter with limited evidence in terms of prevalence, etiology, and effects. The aims of this study were to validate the Italian version of the Second Victim Experience and Support Tool (I-SVEST) and determine its psychometric properties in a group of HCWs exposed to patient safety incidents.

MATERIALS AND METHODS

An observational cross-sectional study was conducted using an online survey. Construct validity for the total score and for each of the 7 subscales was assessed using principal component analysis and internal consistency using Cronbach α coefficient.

RESULTS

The prevalence of second victims in our sample was 35.4% (85/240). The component SVEST was positively associated with turnover intentions but not directly related to absenteeism and sociodemographic characteristics. Absenteeism and sociodemographic characteristics components were positively associated with turnover intentions. Factor analysis confirmed that the questionnaire has 7 dimensions: psychological distress, physical distress, colleague support, supervisor support, institutional support, non-work-related support, and professional self-efficacy. Cronbach α for the Italian version was strong at α = 0.855. Cronbach α ranged from 0.613 for colleague support to 0.882 for supervisor support.

CONCLUSIONS

The Italian version of the SVEST has excellent psychometric properties and can be used to detect prevalence in different contexts, to support studies and preventive interventions for Italian HCWs. The SVEST provides a robust model to describe the concept of second victim and to conduct comparisons with cross-sectional and longitudinal studies.

Tele-Monitoring System for Chronic Diseases Management: Requirements and Architecture

In the last years a large variety of eHealth services and Apps for professional medical users have been developed for different scenarios. The increasing elderly population (+100% in 2050) makes urgent to implement tele-medicine paradigm in the healthcare structures. The need of monitoring large number of patients distributed over the territory, together with the lack of medical resources, makes the adoption of Information Communication Technologies (ICT) crucial for the future healthcare services. This paper presents an ICT architecture model for the provision of tele-monitoring services within a novel proposed remote monitoring concept for healthcare, considering the new Family and Community Nurse (FCN). An integrated and personalized tele-monitoring solution is presented, through a detailed description of the reference network architecture and service platform. Moreover, the preliminary results of the experimental activities carried out for the evaluation of the system in terms of usability in operational scenarios are provided.

Complexity in internal medicine wards: A novel screening method and implications for management

RATIONALE

Complexity is increasingly recognized as a critical variable in health care. However, there is still lack of practical tools to assess it and tackle the challenges that stem from it, particularly within hospitals.

AIMS AND OBJECTIVE

To validate a simple novel screening method based on both objective and subjective criteria to identify patients with clinically complex hospitalization events. To evaluate the prevalence of patients with complex events, identify their features, and compare them with those of the other patients and to those of patients with multimorbidities.

METHOD

We monitored the level of complexity of the hospitalization events of 240 patients admitted to an internal medicine ward in Tuscany over the course of 56 days. We compared the demographic features, the length of stay, and the prognosis of patients with and without complex events.

RESULTS

Sixty-nine patients (28.8% of the sample) had a complex episode during their stay, and 115 (47.9%) had phases of low complexity. Patients with complex episodes were younger and more comorbid than patients without. They stayed longer in-hospital (+4.5 days; 95% CI: 2.5-6.5) and had higher mortality (OR: 24.93; 95% CI: 6.97-171.63) and a lower probability of home discharge (OR: 0.25; 95% CI: 0.13-0.48).

CONCLUSIONS

The results show that using a simple screening method is possible to identify complex patients within IM wards and that every day, about one-third of the patients are complex. The results are discussed in implications for the dynamic management of patients with complex and simple phases during hospitalization.