To be or not to beintensive: Internal Medicine unit role during and after CoViD-19 pandemic

Background and Aim: CoViD-19 causes major changes in daily hospital activity, both in clinician and organizational aspects. Aim of this research is investigated a new model of Internal Medicine Unit. ASL Roma 6 is a local health facilities where hospital, territorial medicine and low-care facilities are integrated. Materials and Methods: Initially, Delphi method (by six experts with clinician, statistic, health economic and public health expertise) allowed to analyze bad outcome causes in Ospedale dei Castelli's CoViD wards cohort (Lazio, Italy) via Ishikawa diagram and to create a SWOT analysis table. At the least, a Barber-Johnson's nomogram has been made with performances of MC (Medicine- CoViD) and MCF (Medicine-CoViD-free) units considering: length of the stay, bed occupation ratio, turn over interval and bed rotation index. CoViD-three-waves have been considered alone and overall. Results: MCF hospitalized 790 patients (-23,90% compared to 2019 Internal Medicine admission), MC hospitalized 350 patients (M 199/F151). Main risk factor for mortality: patients admitted from local facilities (+7%, 57,14% of overall CoViD deaths) and presence of comorbidities (>3: 100%, =5: 24,7%). 197 (25%) patients have been treated with non-invasive ventilation (NIV). Conclusions: CoViD Medicine wards show higher complexity and demand compared to non-CoViD ones, comparable to Sub-Intensive Therapy units;it is necessary to promote the NIV usage in such setting and to use CoViD expertise to build a new hospital model, where Internal Medicine is the core of care, integrated with territorial medicine.

The metamorphosis of the field facilities organizationalmodel for vulnerable population protection in COVID-19infection: Mortality risk factors and management solutions

Background: Asl Roma 6 (population served 531,177 inhabitants) is a healthcare company characterized by strong hospitalfield integration due to the presence of 4 hospitals, 6 districts andover 36 low-intensity field facilities for frail elderly. Equipped withCovid Hospital within an active field surveillance system.Materials and Methods: Retrospective evaluation of the mortalityof patients admitted to Covid Medicine with identification of riskfactors and proposal of innovative risk reduction models. Results: 85 patients admitted (49F, 36M);average age 77 years;68% with>3 comorbidities;deaths 28% with average age 86.8years. Main risk factors: transferred from low intensity field facilities(100%), old age and comorbidities>3 (100%), followed by Covid-19 WHO Stage 3 (70%);IRC (58%);neoplasm (41%), D-Dimerat the entrance>500 (50%). Conclusions: To effectively carry out emergency preparednessactions it is necessary to introduce new organizational modelsaimed at the reorganization of activities specifically within thefield facilities for the elderly currently implemented in Asl Roma6: 1. acceptance only after 2 negative swabs;2. isolation withquarantine inside the structure and subsequently accomodationwith other patients;3. monitoring by periodic swabs;4. socialdistancing and PPE (Personal Protective Equipment) use. Prevention with selective isolation of vulnerable patients is the bestoption to reduce mortality as intensive care was not effective inavoiding deaths (10% of patients undergoing NIV- Non InvasiveVentilation with little benefit).