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The Fenice project to evaluate and improve the quality of healthcare in high-dependency care units: results after the first year

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Abstract

High-Dependency care Units (HDUs) have been introduced worldwide as intermediate wards between Intensive Care Units (ICUs) and general wards. Performing a comparative assessment of the quality of care in HDU is challenging because there are no uniform standards and heterogeneity among centers is wide. The Fenice network promoted a prospective cohort study to assess the quality of care provided by HDUs in Italy. This work aims at describing the structural characteristics and admitted patients of Italian HDUs. All Italian HDUs affiliated to emergency departments were eligible to participate in the study. Participating centers reported detailed structural information and prospectively collected data on all admitted adult patients. Patients’ data are presented overall and analyzed to evaluate the heterogeneity across the participating centers. A total of 12 HDUs participated in the study and enrolled 3670 patients. Patients were aged 68 years on average, had multiple comorbidities and were on major chronic therapies. Several admitted patients had at least one organ failure (39%). Mortality in HDU was 8.4%, raising to 16.6% in hospital. While most patients were transferred to general wards, a small proportion required ICU transfer (3.9%) and a large group was discharged directly home from the HDU (31%). The expertise of HDUs in managing complex and fragile patients is supported by both the available equipment and the characteristics of admitted patients. The limited proportion of patients transferred to ICUs supports the hypothesis of preventing of ICU admissions. The heterogeneity of HDU admissions requires further research to define meaningful patients’ outcomes to be used by quality-of-care assessment programs.

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Data availability

The data that support the findings of this study are not openly available due to reasons of sensitivity.

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Acknowledgements

The start of the Fenice HDU project was partially supported by an unconditioned grant from the Italian Society of Emergency Medicine (SIMEU).

Funding

Italian Society of Emergency Medicine (SIMEU), Unconditioned grant.

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, Santa Maria Delle Grazie Hospital, Pozzuoli, Naples, Italy

    Giovanni Porta

  2. Department of Medical Epidemiology, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, 24020, Ranica, Bergamo, Italy

    Fabiola Signorini, Carlotta Rossi, Giulia Irene Ghilardi, Michele Zanetti, Daniela Zatelli, Giovanni Nattino & Guido Bertolini

  3. High Dependency Unit, San Giovanni Bosco Hospital, Turin, Italy

    Marcella Converso, Giulia Cavalot & Franco Aprà

  4. Department of Emergency Medicine, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy

    Valeria Caramello & Adriana Boccuzzi

  5. Pronto Soccorso E Medicina d’Urgenza, Ca Foncello ULSS9, Treviso, Italy

    Angela Beltrame

  6. Department of Emergency Medicine, Azienda Ospedaliera SS. Antonio E Biagio E Cesare Arrigo, Alessandria, Italy

    Riccardo Boverio

  7. Pronto Soccorso E Medicina d’Urgenza, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Universitario “Santa Maria Della Misericordia” Di Udine, Udine, Italy

    Mario Calci

  8. Emergency Department, S. Eugenio Hospital, Rome, Italy

    Ersilia Castaldo & Enrico Mirante

  9. Emergency Medicine Unit, A.O. Parini, Aosta, Italy

    Michele Covella

  10. Emergency Medicine, Bufalini Hospital, Cesena, Italy

    Patrizia Cuppini

  11. Department of Emergency Medicine, Azienda Ospedaliero Universitario Policlinico G. Rodolico—San Marco, Catania, Italy

    Paola Noto

  12. Emergency Medicine, S. Maria Delle Croci Hospital, Ravenna, Italy

    Lucia Pierpaoli

  13. Emergency Medicine, A.O.U. Sassari, Sassari, Italy

    Paolo Pinna Parpaglia

  14. Emergency Medicine, Edoardo Agnelli Hospital, Pinerolo, Turin, Italy

    Alberto Ricchiardi

Authors
  1. Giovanni Porta
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  2. Fabiola Signorini
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  3. Marcella Converso
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  4. Giulia Cavalot
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  5. Valeria Caramello
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  6. Carlotta Rossi
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  7. Franco Aprà
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  8. Angela Beltrame
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  9. Adriana Boccuzzi
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  10. Riccardo Boverio
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  11. Mario Calci
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  12. Ersilia Castaldo
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  13. Michele Covella
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  14. Patrizia Cuppini
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  15. Giulia Irene Ghilardi
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  16. Enrico Mirante
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  17. Paola Noto
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  18. Lucia Pierpaoli
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  19. Paolo Pinna Parpaglia
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  20. Alberto Ricchiardi
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  21. Michele Zanetti
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  22. Daniela Zatelli
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  23. Giovanni Nattino
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  24. Guido Bertolini
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Contributions

The authors substantially contributed to the paper as follows: conception and design (GP, FS, MC, GC, VC, CR, FA, AB, RB, MC, EC, PC, GIG, PN, LP, PPP, SP, AR, GN, GB), analysis (FS, CR, GN) and interpretation (all authors) of data, drafting the article (GP, FS, MC, GC, VC, GN, GB) or critical revision (all authors). All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Carlotta Rossi.

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Conflict of interests

None of the authors has any conflict of interest in relation to this work.

Ethical Approval

The study was approved by the ethics committee of the Fondazione IRCCS Istituto Neurologico “Carlo Besta” and by the institutional review boards of all participating centers.

Informed consent

Informed consent was obtained from patients or legal representatives.

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Porta, G., Signorini, F., Converso, M. et al. The Fenice project to evaluate and improve the quality of healthcare in high-dependency care units: results after the first year. Intern Emerg Med (2024). https://doi.org/10.1007/s11739-024-03640-5

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