SUPPLEMENTAL MATERIAL

Methodological tools implemented in the Internal Medicine and Critical Subacute Care Unit of Parma University Hospital in order to improve efficiency and appropriateness of care for elderly multimorbid frail patients. These tools have been developed together with the activation of the “intensity of care” unit model described in the main text. References are also cited in the main text.

Tool / Comment/Reference
Anticipation of every patient’s needs according to lean methodology / [1-2]
Early identification of personalized diagnostic and therapeutic goals for every patient at the moment of admission
Planning of a comprehensive healthcare program, considering also the familiar and social context of patients, at the moment of admission
Elaboration of a shared discharge plan for every patient within the first 24 hours of stay
Telephone call to every patient’s general practitioner before discharge
Collegial medical rounds once a day for every ward of the unit
Personalized healthcare education for patients, relatives and caregivers
Organizations of physician work schedules according to targets and not on strict shifts, according to the principle of physician accountability / [3]
“Due-bed instrument” (establishment of the minimum number of monthly admissions to be performed in each ward in order to maintain planned length of stay) / Serves as a guide for clinical activity and discharge planning
Everyday collegial sharing of clinical and organizational problems within a specific briefing
Utilization of an operative checklist for a safe hospital discharge
Monitoring of “bed blockers” / [4]
Institution of the “flow manager” figure / Details given in the main text

References

1.  Mazzocato P, Holden RJ, Brommels M, Aronsson H, Backman U, Elg M, Thor J (2012) How does lean work in emergency care? A case study of a lean-inspired intervention at the Astrid Lindgren Children’s hospital, Stockholm, Sweden. BMC Health Serv Res 12:28.

2.  Andersen H, Rovik KA, Ingebrigtsen T (2014) Lean thinking in hospitals: is there a cure for the absence of evidence? A systematic review of reviews. BMJ Open 4:e003873.

3.  Caminiti C, Meschi T, Braglia L, Diodati F, Iezzi E, Marcomini B, Nouvenne A, Palermo E, Prati B, Schianchi T, Borghi L (2013) Reducing unnecessary hospital days to improve quality of care through physician accountability: a cluster randomized trial. BMC Health Serv Res 13:14.

4.  Meschi T, Nouvenne A, Maggio M, Lauretani F, Borghi L (2012) Bed-blockers: an 8 year experience of clinical management. Eur J Intern Med 23(2):e73-e74.

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