Are there important differences in comorbidity between surgical and medical inpatients?

BACKGROUND AND OBJECTIVE: Scientific and technological advances are changing medical practice and transforming hospitals, and both the age and comorbidities of hospitalized patients are rapidly increasing. The increasing complexity of these patients and the scant clinical differences between medical and surgical inpatients calls for changes in the organization and delivery of in-hospital care. Our objective has been to assess differences in age and comorbidity between surgical and medical inpatients. MATERIALS AND METHODS: Retrospective, observational, descriptive study in patients aged ≥16 years discharged from all medical and surgical services during 2019, except for obstetrics and intensive care. All data were obtained from the hospital's minimum basic data set and analyzed using univariate analysis. RESULTS: The study included 31,264 patients: 16,397 from the medical area and 14,867 from the surgical area. Those in the surgical area were 8 years younger (62.69 years [95% CI 62.4-62.98]), with a slightly higher proportion of women (OR 1.12 [95% CI 1.07-1.17]) compared to the medical area, and fewer non-scheduled admissions (OR 0.11 [95% CI 0.10-0.12]). There were no significant differences in comorbidity burden between study groups. CONCLUSIONS: Patients in the surgical area have a high burden of medical comorbidity, similar to those in the medical area. This information is important for surgeons and anesthetists, and should compel hospitals to change the current organizational model.

¿Hay diferencias importantes en la comorbilidad entre los pacientes ingresados en servicios quirúrgicos y los ingresados en servicios médicos? / Are there important differences in comorbidity between surgical and medical inpatients?

Antecedentes y objetivo: El desarrollo científico y tecnológico está cambiando la práctica médica y transformando los hospitales, seleccionando los pacientes que permanecen hospitalizados, los cuales están aumentando su edad y comorbilidad. Son cada vez más complejos médicamente y con menos diferencias clínicas entre los pacientes médicos y quirúrgicos, lo que puede implicar cambios organizativos y asistenciales hospitalarios. Nuestro objetivo es valorar las diferencias en la edad y comorbilidad existentes entre los pacientes hospitalizados en las áreas médica y quirúrgica. Materiales y métodos: Estudio descriptivo observacional retrospectivo que ha incluido a los pacientes de edad ≥16 años dados de alta durante el año 2019 de todos los servicios médicos y quirúrgicos, excluidos Obstetricia y Cuidados Intensivos. Los datos se obtuvieron del CMBD del hospital y fueron analizados mediante análisis univariante. Resultados: Se incluyeron 31.264 pacientes, 16.397 del área médica y 14.867 del área quirúrgica. Los del área quirúrgica son 8 años más jóvenes (62,69 años [IC 95% 62,4-62,98]), con mayor proporción de mujeres (OR 1,12 [IC 95% 1,07-1,17]) y menos ingresos urgentes (OR 0,11 [IC 95% 0,10-0,12]). En las variables relacionadas con la carga de comorbilidad los resultados entre ambos grupos de pacientes son similares en todas ellas y sin diferencias significativas. Conclusiones: Los enfermos del área quirúrgica tienen una alta carga de comorbilidad médica, similar a los del área médica. Conocer este dato es importante para cirujanos y anestesistas y abre la puerta para planear alternativas a la organización hospitalaria actual.(AU)

Background and objective: Scientific and technological advances are changing medical practice and transforming hospitals, and both the age and comorbidities of hospitalized patients are rapidly increasing. The increasing complexity of these patients and the scant clinical differences between medical and surgical inpatients calls for changes in the organization and delivery of in-hospital care.Our objective has been to assess differences in age and comorbidity between surgical and medical inpatients. Materials and methods: Retrospective, observational, descriptive study in patients aged ≥ 16 years discharged from all medical and surgical services during 2019, except for obstetrics and intensive care. All data were obtained from the hospital's minimum basic data set and analyzed using univariate analysis. Results: The study included 31,264 patients: 16,397 from the medical area and 14,867 from the surgical area. Those in the surgical area were 8 years younger (62.69 years [95% CI 62.4-62.98]), with a slightly higher proportion of women (OR 1.12 [95% CI 1.07-1.17]) compared to the medical area, and fewer non-scheduled admissions (OR 0.11 [95% CI 0.10-0.12]). There were no significant differences in comorbidity burden between study groups. Conclusions: Patients in the surgical area have a high burden of medical comorbidity, similar to those in the medical area. This information is important for surgeons and anesthetists, and should compel hospitals to change the current organizational model.(AU)

Breve historia de la interconsulta médica / A brief history of medical cross-consultations

Desde la Antigüedad los médicos han necesitado, y solicitado, el apoyo y consejo de colegas experimentados. Esta práctica fue refrendada por Hipócrates y Galeno, permaneciendo sin cambios hasta la Ilustración. En ese período, la interconsulta alcanzó un gran auge. Se escribieron libros monográficos, se estudiaron las características y cualidades que debía poseer el médico consultor y los problemas que podía originar, y se establecieron reglas y pautas a seguir durante su desarrollo. Esta situación se mantuvo estable hasta finales del siglo xix, cuando la aparición de diversas especialidades médicas ofreció la posibilidad de buscar ayuda especializada. Esta especialización originó una fragmentación de la asistencia médica, lo que favoreció la aparición del internista como «consultor universal». En el último cuarto del siglo xx, ante la importancia y problemas de la interconsulta, se comienza a desarrollar su estudio, se crean servicios especializados en su resolución y, finalmente, aparece la asistencia compartida (AU)

Physicians have long needed and sought out the support and advice of experienced colleagues. This practice, endorse by Hippocrates and Galen, remaining unchanged until the Enlightenment. During that age, cross-consultations boomed. Monographic works were written, the characteristics and qualities that consulting physician had to possess were studied the problems that it could cause were examined, and rules and guidelines to follow during a cross-consultation were established. It remained unchanged until the end of the 19th century, when the emergence of various medical specialties offered the possibility of seeking specialized assistance. This specialization gave rise to a fragmentation of medical care which favored the emergence of the internist as a “universal consultant.” In the last quarter of the 20th century, in light of the importance of and problems arising from cross-consultation, it began to be studied on its own, specialized services were created to attend to them, and, finally, comanagement appeared (AU)

[Relevance of empirical antibiotic treatment in the evolution of prosthetic joint infection treated with implant retention]. / Relevancia del tratamiento antibiótico empírico en la evolución de la infección de prótesis articular tratada con retención del implante.

OBJECTIVE: Several factors have been associated with the prognosis of prosthetic joint infection (PJI) treated with surgical debridement, antibiotic therapy, and implant retention (DAIR). There is no evidence about the right empirical antibiotic treatment when the causal microorganism is not still identified. METHODS: We conducted a retrospective observational study in patients with PJI treated with DAIR between 2009 and 2018 in our center. We analyze the risk factors related with their prognosis and the influence of active empirical antibiotic therapy against causative microorganisms in final outcomes. RESULTS: A total of 80 PJI cases treated with DAIR, from 79 patients (58.7% women, mean age 76.3 years), were included in the study period. Among the cases in which empirical antibiotic therapy were active against the causative microorganisms, the success rate was 46/65 (69.2%) vs 1/15 when not (6.7%, OR 31.5, p = 0.001). Factors related to the success or failure of the DAIR were analyzed with multivariate analysis. We found that active empirical antibiotic treatment remained statistically significant as a good prognostic factor (OR 0.04, p <0.01). CONCLUSIONS: Empirical antibiotic treatment could be an important factor in the prognosis of PJI treated with DAIR. To identify cases at risk of infection by multidrug resistant microorganisms could be useful to guide empirical antibiotic therapy.

A brief history of medical cross-consultations.

Physicians have long needed and sought out the support and advice of experienced colleagues. This practice, endorse by Hippocrates and Galen, remaining unchanged until the Enlightenment. During that age, cross-consultations boomed. Monographic works were written, the characteristics and qualities that consulting physician had to possess were studied the problems that it could cause were examined, and rules and guidelines to follow during a cross-consultation were established. It remained unchanged until the end of the 19th century, when the emergence of various medical specialties offered the possibility of seeking specialized assistance. This specialization gave rise to a fragmentation of medical care which favored the emergence of the internist as a "universal consultant." In the last quarter of the 20th century, in light of the importance of and problems arising from cross-consultation, it began to be studied on its own, specialized services were created to attend to them, and, finally, comanagement appeared.

[Outcomes of comanagement with Internal Medicine in Otolaryngology]. / Resultados de la asistencia compartida con Medicina Interna en Otorrinolaringología.

BACKGROUND AND OBJECTIVE: The age and comorbidity of patients admitted to Otolaryngology are increasing, leading to increased consultations/referrals to Internal Medicine, but do not reach the required effectiveness. An alternative is comanagement. A study is conducted on the effect of comanagement on Otolaryngology. METHODS: A retrospective observational study was conducted on patients ≥16 years old admitted in Otolaryngology between 03 December 2017 and 03 December 2019, since 03/12/2018 with comanagement with Internal Medicine since 03 December 2018. An analysis was performed on age, gender, type of admission, and whether the patient had surgery, administrative weight associated with (diagnosis-related group) DRG, total number of diagnoses at discharge, Charlson comorbidity index, deaths, urgent readmissions, and length of stay. RESULTS: Comanaged patients were younger (3.1 years, 95% confidence interval [95% CI] 1.4 to 4.8), but with higher Charlson comorbidity index (0.2; 95% CI; 0.1 to 0.3), number of diagnoses (0.9; 95% CI; 0.6 to 1.2), and administrative weight (0.04; 95% CI; 0 to 0.09). On adjustment, comanagement reduced Otolaryngology length of stay by 26.7%, 0.8 days (95% CI; 0.3 to 1.3), 50% of urgent readmissions, and 60% mortality, both non-significant. The decrease in length of stay implies an Otolaryngology savings of at least € 320,476.5. CONCLUSIONS: Patients admitted to Otolaryngology are increasing in age and comorbidity. Comanagement is associated with reduced length of stay and costs similar to those observed in other surgical services.

¿Qué pacientes quirúrgicos necesitan asistencia compartida? / Which surgical patients require shared care?

La mayoría de los pacientes quirúrgicos hospitalizados tiene mucha comorbilidad médica y recibe un gran número de medicaciones, o sufre complicaciones importantes, o ambos. La asistencia compartida (AC) es la responsabilidad y autoridad compartidas en el manejo de un paciente hospitalizado. Se discute si se deben seleccionar o no pacientes para la AC. Los diferentes criterios de selección no son seguros o fáciles de aplicar, y dejan fuera a muchos pacientes subsidiarios de AC. El manejo perioperatorio es fundamental para la mortalidad postoperatoria. El fallo del rescate (mortalidad hospitalaria secundaria a complicaciones posquirúrgicas) es el principal factor sobre la mortalidad quirúrgica hospitalaria. Afecta a cualquier paciente, independientemente de su edad, comorbilidad o tipo de cirugía. El componente que reduce más el fallo de rescate es la presencia de internistas en las salas quirúrgicas. Consideramos que todos los enfermos hospitalizados en los servicios quirúrgicos deberían recibir AC

Most hospitalized surgical patients have significant medical comorbidity and are treated with a considerable number of drugs and/or experience significant complications. Shared care (SC) is the shared responsibility and authority in managing hospitalized patients. In this article, we discuss whether patients should be selected for SC or not. The various selection criteria are not an exact science nor are they easy to apply. Furthermore, they may leave out many patients who may be good candidates for SC. Perioperative management is essential for preventing postoperative mortality. Failure to rescue (in-hospital mortality secondary to postoperative complications) is the main factor linked to in-hospital surgical mortality and can affect any patient regardless of age, comorbidity, or type of surgery. The component that most reduces failure to rescue is the presence of internists in surgical wards. We believe that all patients hospitalized in surgery departments should receive SC

Which surgical patients require shared care? / ¿Qué pacientes quirúrgicos necesitan asistencia compartida?

Most hospitalized surgical patients have significant medical comorbidity and are treated with a considerable number of drugs and/or experience significant complications. Shared care (SC) is the shared responsibility and authority in managing hospitalized patients. In this article, we discuss whether patients should be selected for SC or not. The various selection criteria are not an exact science nor are they easy to apply. Furthermore, they may leave out many patients who may be good candidates for SC. Perioperative management is essential for preventing postoperative mortality. Failure to rescue (in-hospital mortality secondary to postoperative complications) is the main factor linked to in-hospital surgical mortality and can affect any patient regardless of age, comorbidity, or type of surgery. The component that most reduces failure to rescue is the presence of internists in surgical wards. We believe that all patients hospitalized in surgery departments should receive SC.

Modelos colaborativos hospitalarios de asistencia compartida e interconsultas a demanda. ¿Cuál ofrece mejores resultados en Cirugía Ortopédica y Traumatología? / Collaborative hospital models for shared care and on-demand interconsultations. Which offer the best results for Orthopaedic Surgery and Trauma?

ANTECEDENTES Y OBJETIVO: Los enfermos quirúrgicos hospitalizados están aumentando su complejidad médica, incrementando la necesidad de apoyo por Medicina Interna. Este apoyo se realiza mediante la interconsulta, la cual presenta problemas que han inducido el desarrollo de la asistencia compartida (AC). Nuestro objetivo es comparar los resultados asistenciales alcanzados por los modelos de interconsulta y AC en Cirugía Ortopédica y Traumatología. MATERIAL Y MÉTODO: Estudio observacional, prospectivo, multicéntrico, de los enfermos hospitalizados de urgencia en Cirugía Ortopédica y Traumatología recogidos en el registro REINA-SEMI, atendidos por Medicina Interna mediante interconsulta o AC. Se registraron las características demográficas, comorbilidad, complicaciones médicas, estancia hospitalaria y mortalidad. RESULTADOS: Se incluyeron 697 pacientes, 415 con AC y 282 con interconsulta. Los de AC tenían más edad (78,9 vs. 74,3; p <0,001), se operaron más (89,9 vs. 78,7%; p <0,001), tuvieron menos complicaciones médicas (50,4 vs. 62,8%; p <0,001) y su estancia hospitalaria fue menor (10 vs. 18 días; p <0,001), sin diferencias en la comorbilidad ni mortalidad. Los factores independientes asociados a estancia superior a 15 días fueron: insuficiencia cardiaca (OR: 3,4; IC 95%: 1,8-6,1; p <0,001), sexo (hombre) (OR: 1,9; IC 95%: 1,2-3,1; p = 0,004), trastorno electrolítico (OR: 2,4; IC 95%: 1,3-4,4; p = 0,003), infección respiratoria (OR: 1,9; IC 95%: 1,04-3,7; p = 0,035), demora quirúrgica (OR: 1,1; IC 95%: 1,08-1,2; p <0,001) y ser atendido mediante el modelo de interconsulta a demanda (OR: 3,5; IC 95%: 2,3-5,4; p <0,001). CONCLUSIONES: La AC ofrece mejores resultados asistenciales que las interconsultas en pacientes ingresados de urgencia en Cirugía Ortopédica y Traumatología

BACKGROUND AND OBJECTIVES: Hospitalized surgical patients are increasing in medical complexity, thereby increasing the need for support by internal medicine departments. This support is provided through interconsultations, which present problems that have resulted in the development of shared care (SC). Our objective was to compare the healthcare results achieved by the SC and interconsultation models in Orthopaedic Surgery and Trauma. MATERIALS AND METHODS: We conducted an observational, prospective, multicentre study of patients hospitalized for emergency Orthopaedic Surgery and Trauma recorded in the REINA-SEMI registry, treated by internal medicine departments through interconsultation or SC. We recorded the demographic characteristics, comorbidity, medical complications, hospital stay and mortality. RESULTS: The study included 697 patients, 415 with SC and 282 with interconsultations. The SC patients were older (78.9 vs. 74.3; P<.001) underwent more operations (89.9 vs. 78.7%; P<.001), had fewer medical complications (50.4 vs. 62.8%; P<.001) and had shorter hospital stays (10 vs. 18 days; P<.001), with no differences in comorbidity or mortality. The following independent factors were associated with stays longer than 15 days: heart failure (OR 3.4; 95% CI 1.8-6.1; P<.001), the male sex (OR 1.9; 95% CI 1.2-3.1; P=.004), electrolyte disorder (OR 2.4; 95% CI 1.3-4.4; P=.003), respiratory infection (OR 1.9; 95% CI 1.04-3.7; P=.035), surgical delay (OR 1.1; 95% CI 1.08-1.2; P<.001) and treatment using the interconsultation on demand model (OR 3.5; 95% CI 2.3-5.4; P<.001). CONCLUSIONS: SC offers better healthcare results than interconsultations for patients hospitalized for emergency Orthopaedic Surgery and Trauma

Collaborative hospital models for shared care and on-demand interconsultations. Which offer the best results for Orthopaedic Surgery and Trauma? / Modelos colaborativos hospitalarios de asistencia compartida e interconsultas a demanda. ¿Cuál ofrece mejores resultados en Cirugía Ortopédica y Traumatología?

BACKGROUND AND OBJECTIVES: Hospitalized surgical patients are increasing in medical complexity, thereby increasing the need for support by internal medicine departments. This support is provided through interconsultations, which present problems that have resulted in the development of shared care (SC). Our objective was to compare the healthcare results achieved by the SC and interconsultation models in Orthopaedic Surgery and Trauma. MATERIALS AND METHODS: We conducted an observational, prospective, multicentre study of patients hospitalized for emergency Orthopaedic Surgery and Trauma recorded in the REINA-SEMI registry, treated by internal medicine departments through interconsultation or SC. We recorded the demographic characteristics, comorbidity, medical complications, hospital stay and mortality. RESULTS: The study included 697 patients, 415 with SC and 282 with interconsultations. The SC patients were older (78.9 vs. 74.3; P<.001) underwent more operations (89.9 vs. 78.7%; P<.001), had fewer medical complications (50.4 vs. 62.8%; P<.001) and had shorter hospital stays (10 vs. 18 days; P<.001), with no differences in comorbidity or mortality. The following independent factors were associated with stays longer than 15 days: heart failure (OR 3.4; 95% CI 1.8-6.1; P<.001), the male sex (OR 1.9; 95% CI 1.2-3.1; P=.004), electrolyte disorder (OR 2.4; 95% CI 1.3-4.4; P=.003), respiratory infection (OR 1.9; 95% CI 1.04-3.7; P=.035), surgical delay (OR 1.1; 95% CI 1.08-1.2; P<.001) and treatment using the interconsultation on demand model (OR 3.5; 95% CI 2.3-5.4; P<.001). CONCLUSIONS: SC offers better healthcare results than interconsultations for patients hospitalized for emergency Orthopaedic Surgery and Trauma.

Análisis de la actividad de interconsulta realizada por los servicios de medicina interna. Estudio REINA-SEMI: Registro de Interconsultas y Asistencia Compartida de la Sociedad Española de Medicina Interna / Analysis of the activity of interconsultations conducted by the departments of internal medicine. REINA-SEMI study: Registry of Interconsultations and Shared Care of the Spanish Society of Internal Medicine

Objetivo: Analizar la actividad de interconsulta (IC) realizada por los servicios de medicina interna (MI), sus aspectos formales, el perfil de la atención clínica requerida y cuantificar la carga de trabajo que supone. Material y método: Estudio multicéntrico, observacional, prospectivo, sobre enfermos consecutivos hospitalizados atendidos por servicios de MI mediante IC entre el 15 de mayo y el 15 de junio del año 2016. Se estimó la carga de trabajo relacionada con dicha actividad (1UT=10min). Resultados: Se registraron 1.141 IC procedentes de 43 hospitales, edad 69,4 (DE: 16,2) años, 51,2% hombres. El índice de Charlson fue 2,3 (DE: 2,2). Los motivos de consulta más frecuentes fueron: valoración general (27,4%), fiebre (18,1%), disnea (13,6%), trastorno metabólico (9,6%), HTA (6,3%) y síndrome confusional (5,3%). Las UT estimadas fueron 4 (DE: 5,9) para la primera visita y 7,3 (DE: 21,5) para la suma de las sucesivas. Los pacientes quirúrgicos fueron mayores (70,6 [DE: 15,9] vs 64,4 [DE: 16,3]; p=0,0001) y precisaron más días de seguimiento (5 [DE: 7,3] vs 3,5 [DE: 4,2]; p=0,009). Los siguientes aspectos fueron más frecuentes en el formato de las IC realizadas por servicios médicos: número de IC ordinarias (respuesta >24h), especificación del motivo de IC, datos mínimos referentes a la historia clínica y coincidencia de la adecuación en el tiempo con el consultor. Conclusión: Los pacientes atendidos mediante IC por los servicios de MI representan una carga de trabajo importante. La adecuación al formato de solicitud de IC es mayor en las procedentes de servicios médicos

Objective: To analyse the activity of interconsultations conducted by internal medicine (IM) departments, their formal aspects and the profile of clinical care required and to quantify the workload they represent. Material and method: A multicentre, observational prospective study was conducted with consecutive hospitalised patients treated by IM departments using interconsultations between May 15 and June 15, 2016. We estimated the workload related to this activity (1time unit [TU]=10min). Results: We recorded 1,141 interconsultations from 43 hospitals. The mean age of the patients involved was 69.4 years (SD: 16.2), and 51.2% were men. The mean Charlson index was 2.3 (SD: 2.2). The most common reasons for the consultations were general assessments (27.4%), fever (18.1%), dyspnoea (13.6%), metabolic disorder (9.6%), arterial hypertension (6.3%) and delirium (5.3%). The duration of the first visit was 4 TUs (SD: 5.9) and 7.3 (SD: 21.5) for the sum of all subsequent visits. The surgical patients were older (70.6 [SD, 15.9] vs. 64.4 [SD, 16.3] years; P=.0001) and required more follow-up time (5 [SD, 7.3] vs. 3.5 [SD, 4.2] days; P=.009). The following issues were more common in the interconsultation format performed by medical services: number of regular interconsultations (response >24h), specification of the reason for the interconsultation, minimal data regarding the medical history and agreement on the appropriateness of the time spent with the consultant. Conclusion: The patients treated through interconsultations by the IM departments represented a significant workload. The interconsultations from the medical departments were more in line with the request format

Analysis of the activity of interconsultations conducted by the departments of internal medicine. REINA-SEMI study: Registry of Interconsultations and Shared Care of the Spanish Society of Internal Medicine. / Análisis de la actividad de interconsulta realizada por los servicios de medicina interna. Estudio REINA-SEMI: Registro de Interconsultas y Asistencia Compartida de la Sociedad Española de Medicina Interna.

OBJECTIVE: To analyse the activity of interconsultations conducted by internal medicine (IM) departments, their formal aspects and the profile of clinical care required and to quantify the workload they represent. MATERIAL AND METHOD: A multicentre, observational prospective study was conducted with consecutive hospitalised patients treated by IM departments using interconsultations between May 15 and June 15, 2016. We estimated the workload related to this activity (1time unit [TU]=10min). RESULTS: We recorded 1,141 interconsultations from 43 hospitals. The mean age of the patients involved was 69.4 years (SD: 16.2), and 51.2% were men. The mean Charlson index was 2.3 (SD: 2.2). The most common reasons for the consultations were general assessments (27.4%), fever (18.1%), dyspnoea (13.6%), metabolic disorder (9.6%), arterial hypertension (6.3%) and delirium (5.3%). The duration of the first visit was 4 TUs (SD: 5.9) and 7.3 (SD: 21.5) for the sum of all subsequent visits. The surgical patients were older (70.6 [SD, 15.9] vs. 64.4 [SD, 16.3] years; P=.0001) and required more follow-up time (5 [SD, 7.3] vs. 3.5 [SD, 4.2] days; P=.009). The following issues were more common in the interconsultation format performed by medical services: number of regular interconsultations (response >24h), specification of the reason for the interconsultation, minimal data regarding the medical history and agreement on the appropriateness of the time spent with the consultant. CONCLUSION: The patients treated through interconsultations by the IM departments represented a significant workload. The interconsultations from the medical departments were more in line with the request format.

¿Existe una creciente dificultad en el manejo de los pacientes hospitalizados en servicios médicos? / Is there increasing difficulty in managing patients hospitalized in medical services?

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Mejora de parámetros asistenciales y económicos mediante asistencia compartida con medicina interna en pacientes psiquiátricos ingresados / Benefits of comanagement with internal medicine on health care and economic outcomes in psychiatric inpatients

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Encuesta nacional sobre la actividad de los internistas en asistencia compartida-interconsultas en los hospitales españoles / National survey on the activity of internists in shared care-interconsultations in spanish hospitals

Objetivos. Analizar la actividad de interconsulta (IC), realizada por los Servicios de Medicina Interna (SMI), transmitir su importancia a los gestores y ofrecer información a los SMI para mejorar la organización de la misma. Métodos. Estudio transversal mediante una encuesta de actividad en IC (actividad de consultoría a demanda para otros servicios) y asistencia compartida (actividad de consultoría que se presta de modo reglado en otros servicios). Resultados. Se recibieron 120 encuestas que correspondían a 108 hospitales públicos y 12 privados. El 45% de los hospitales encuestados disponen de unidad de IC monográfica y en el 31% existe asistencia compartida. El servicio más frecuentemente asistido por una consultoría estable (65% de los casos) fue cirugía ortopédica y traumatología. El 55% de los SMI encuestados lleva un registro de la actividad de IC desde el inicio de su actividad. El 92% de los servicios carece de un protocolo que regule la IC y en el 74% de los casos la IC se responde a demanda. Conclusiones. La actividad de IC está generalizada en los SMI, pero solo el 45% de ellos disponen de unidades de IC y el 33% prestan la modalidad de asistencia compartida. La encuesta refleja carencias de formación y cierta confusión en el concepto de IC. La gran mayoría de los servicios carecen de protocolos organizativos de IC (AU)

Objectives. To analyse the activity of interconsultations conducted by the departments of internal medicine, communicating their importance to managers and offering information to these departments to improve their organisation. Methods. A cross-sectional study was conducted using an interconsultation activity survey (on-demand consulting activity for other departments) and shared care (consulting activity provided in a regulated manner to other departments). Results. We received 120 surveys that corresponded to 108 public and 12 private hospitals. Forty-five percent of the surveyed hospitals had a specialised interconsultation unit, and 31% had shared care. The department most frequently helped by the presence of a stable consultation unit (65% of the cases) was orthopaedic and trauma surgery. Fifty-five percent of the departments of internal medicine surveyed had an interconsultation activity record since the start of their activity. Ninety-two percent of the departments lacked a protocol that regulated interconsultations, and in 74% of the cases, the interconsultation was on demand. Conclusions. The interconsultation activity is generalised in the departments of internal medicine, but only 45% of these departments have interconsultation units, and only 33% provide the shared care modality. The survey reflects the shortcomings of training and some confusion in the concept of interconsultations. The considerable majority of departments lack organisational interconsultation protocols (AU)