Care needs and point prevalence of post-acute patients in the acute medical wards of an Italian hospital

Background: Despite considerable literature identifying large numbers of post-acute patients in acute medical wards, their needs have not been clearly described. Such information is required to plan alternative services. Objective: Identify the size of and care needs of the post-acute population within the group of patients receiving acute medical care in an Italian General Hospital. Setting: Five medical wards of a District General Hospital in Northern Italy Design: Point prevalence survey. Data were collected on all 211 patients using the most recent Italian version of the Appropriateness Evaluation protocol, Barthel Index, and the Northwick Park Dependency Score. Length of stay up to the data collection (index) day and total length of stay were identified and pre- and post-discharge dependence was assessed. Results: The mean of the length of stay of the patients up to the index day was 12 days. Fourtyfour percent of patients were assessed as inappropriate. The mean age was 70 years. They were moderately physically dependent and stayed in hospital for a further 8 days after the day of the survey. The family met most of the care needs both before and after admission to hospital. Inappropriate patients differed little from the appropriate patients in terms of their care needs, which were relatively high. Conclusion: There is scope for the development of alternatives to acute care in the Italian health service but the intensity on non-medical care needs is not discernibly lower than for acute care. Prospective identification of patients who might require such services using tools that focus on needs other than medical needs remains problematic.