Background: The Internal Medicine unit of Sanremo Hospital is not structured with a delimited critical care area; in our ward we admit acute patients, often with medium and high-grade severity illness, with significant comorbility and frailty, and reduced functional autonomy. Materials and Methods and Results: In the last year, 1319 patients were accepted, (M=638, F=681): 1114 from emergency room/emergency Medicine, 159 transferred from other departments and 46 from home or other hospitals. The mean age was 77.4 years. Among these, a significant number (215) had clinical characteristics that warranted hospitalization in a sub-intensive care setting, assessed by an aggregate National Early Warning Score (NEWS-2) at ward admission >5; Many patients had at the same time important comorbidities, frailty and clinical complexity, further accentuated by advanced age. The most frequently treated pathologies were acute respiratory failure (RF) (n=91), heart failure (186), sepsis/septic shock (176), pneumonia without RF (96), AKI (88), pulmonary embolism, metabolic emergencies, oncological diseases with acute complications (113). Conclusions: This framework confirms, particularly in our territorial and organizational context, the persistence of the paradox of Internal Medicine characterized by managing both patients with a medium or low-care complexity and a growing number of patients suffering from severe acute pathology superimposed on multiple chronic conditions, experiencing the daily challenge of clinical complexity management, optimizing progressively decreasing resources.
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