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Resumen La Sociedad Espanola de Medicina Interna ha desarrollado a lo largo de 2018-2019 el proyecto «El hospital del futuro». El hospital del futuro pretende trasladar al contexto del sistema sanitario espanol la reflexion que abordo el Royal College of Physicians en el Reino Unido sobre la organizacion de la asistencia en los hospitales del futuro, desde el conocimiento acumulado sobre el Sistema Nacional de Salud. En el proyecto participaron asimismo numerosas sociedades cientifico-medicas y entidades profesionales del sector salud y asociaciones de pacientes. Este articulo tiene por objeto destacar en 10 puntos las previsiones que consideramos mas relevantes derivadas de este proyecto, dedicando el ultimo a los retos que para la Medicina Interna se deducen de estas propuestas.

Over the course of 2018 and 2019, the Spanish Society of Internal Medicine carried out a project called "The Future Hospital." Based on cumulative knowledge on the Spanish National Health System, this project seeks to transfer the observations on the organization of healthcare in future hospitals made by the Royal College of Physicians in the United Kingdom to the context of the Spanish healthcare system. The project's participants included numerous scientific and medical societies, professional associations in the health sector, and patient associations. This aim of this article is to highlight, in 10 points, predictions that arose from this project that we consider to be the most relevant, reserving the last point for the challenges for the field of internal medicine that can be surmised from these proposals.

Objectives To compare the structure, resources and activity of the internal medicine units (IMUs) of the Spanish National Health System (SNHS) in 2013 and 2016. To analyze the differences between IMUs in 2016 by hospital size. Material and methods We conducted a comparison of 2 descriptive cross-sectional studies of IMUs in general acute care hospitals of the Spanish National Health System, with data referring to 2013 and 2016. The variables were collected via an ad hoc questionnaire (RECALMIN survey). Results Between 2013 and 2016, the demand for care increased dramatically (with an annual average of 11% in hospital discharges and 16% in first consultations), and comorbidity slightly increased (2%). During this period, the mean productivity of IMUs increased 16.7% (0.6 ± 0.3 vs. 0.7 ± 0.3; p = .09), and the mean stay decreased 10% (9 ± 2.2 vs. 8.1 ± 2.1 days; p = .001). Progress in implementing good practices and systematic care for complex chronic patients was scarce. Both surveys found variability among IMUs and marked differences among IMUs of hospitals of different sizes. Conclusions IMUs responded to the increased burden of care they supported during 2013–2016 by improving their efficiency and productivity; however, advances in implementing good practices, including care for chronic complex patients, were scare. The significant variability in the indicators of structure, activity and management models found in 2013 remained in 2016.

Resumen Objetivos Comparar la estructura, recursos y actividad de las Unidades de Medicina Interna (UMI) del Sistema Nacional de Salud (SNS) en 2013 y 2016. Analizar las diferencias entre UMI en 2016 por tamano de hospital. Material y metodos Comparativa de 2 estudios descriptivos transversales de UMI en hospitales generales de agudos del Sistema Nacional de Salud con datos referidos a 2013 y a 2016. Las variables fueron recogidas mediante un cuestionario «ad hoc» (encuesta RECALMIN). Resultados Entre 2013 y 2016 aumento notablemente la demanda asistencial (con un promedio anual del 11% en altas de hospitalizacion y del 16% en primeras consultas) y ligeramente la comorbilidad (2%). En el mismo periodo, aumento un 16,7% la productividad media de las UMI (0,6 + 0,3 vs. 0,7 + 0,3; p = 0,09) y la estancia media disminuyo un 10% (9 + 2,2 vs. 8,1 + 2,1 dias; p = 0,001). Los progresos en la implantacion de buenas practicas y de una atencion sistematica al paciente cronico complejo fueron escasos. La variabilidad entre UMI y las notables diferencias entre UMI de hospitales de tamano distinto fueron hallazgos de ambas encuestas. Conclusiones Las UMI respondieron al aumento de la carga asistencial que soportaron en el periodo 2013-2016 mejorando su eficiencia y productividad, pero los avances en la implantacion de buenas practicas, incluyendo la atencion al paciente cronico complejo, fueron escasos. La importante variabilidad en los indicadores de estructura, actividad y modelos de gestion encontrada en 2013 se mantuvo en 2016.

The Spanish Society of Internal Medicine has developed a consensus document on the standards and recommendations that they consider essential to the organisation of internal medicine units for conducting their activities efficiently and with high quality. We defined 3 groups of key processes: the care of acutely ill adult patients, the comprehensive care of complex chronic patients and the examination of a patient with a difficult diagnosis and no organ-specific disease. As support processes, we identified the structure and operation of the Internal Medicine units. As strategic processes, we identified training and research. The main subprocesses are structured below, and we established the standards and recommendations for each of them. Lastly, we proposed resulting workloads. The prepared standards must be reviewed within a maximum of 4 years.

The Spanish Society of Internal Medicine has developed a consensus document on the standards and recommendations that they consider essential to the organisation of internal medicine units for conducting their activities efficiently and with high quality. We defined 3 groups of key processes: the care of acutely ill adult patients, the comprehensive care of complex chronic patients and the examination of a patient with a difficult diagnosis and no organ-specific disease. As support processes, we identified the structure and operation of the Internal Medicine units. As strategic processes, we identified training and research. The main subprocesses are structured below, and we established the standards and recommendations for each of them. Lastly, we proposed resulting workloads. The prepared standards must be reviewed within a maximum of 4 years.

Objectives To analyze the evolution of care provided by the internal medicine units (IMU) of the Spanish National Health System from 2007 to 2014. Material and methods We analyzed all discharges from the IMU of the Spanish National Health System in 2007 and 2014, using the Minimum Basic Data Set. We compared the risk factors by episode, mortality and readmissions between the two periods. We prepared specific fits for the risk for mortality and readmissions in heart failure, pneumonia and chronic obstructive pulmonary disease, as well as the Charlson index for all activity. Results Discharges from the IMU between the two periods increased 14%. The average patient age increased by 2.8 years (71.2 ± 17.1 vs. 74 ± 16.2; p Conclusions During the analyzed period, there was an increase of almost 3 years in the mean age of patients treated in the IMU of the Spanish National Health System, with a marked increase in comorbidity. These results should lead to a more appropriate assignment of nurse workloads and an increased implementation of good practices in clinical management.

Resumen Objetivos Analizar la evolucion de la asistencia prestada en las Unidades de Medicina Interna (UMI) del Sistema Nacional de Salud en 2007 y 2014. Material y metodos Analisis de todas las altas dadas por las UMI del Sistema Nacional de Salud en los anos 2007 y 2014, utilizando el Conjunto Basico Minimo de Datos. Se contrastaron los factores de riesgo por episodio, mortalidad y reingresos entre ambos periodos. Se elaboraron ajustes especificos de riesgo para la mortalidad y reingresos en la insuficiencia cardiaca, neumonia y enfermedad pulmonar cronica obstructiva, asi como el indice de Charlson para el conjunto de la actividad. Resultados Las altas dadas por las UMI entre ambos periodos aumentaron un 14%. La edad promedio crecio en 2,8 anos (71,2 ± 17,1 vs. 74 ± 16,2; p Conclusiones Durante el periodo analizado ha aumentado en casi tres anos la edad media de los pacientes atendidos en las UMI del Sistema Nacional de Salud, con un notable aumento de la comorbilidad, lo que deberia conllevar una asignacion mas adecuada de las cargas de trabajo de enfermeria, asi como una mayor implantacion de buenas practicas de gestion clinica.

Objectives To perform a situation analysis of the care provided by internal medicine units (IMUs) in Spain and to develop, based on this analysis, proposals for improving the quality of care in these units. Material and methods A descriptive, cross-sectional study of the IMUs of general acute care hospitals of the Spanish National Health System (SNHS), with data referring to 2013. The study variables were collected via an ad hoc questionnaire. Results Of the total 260 hospitals identified in the SNHS, 142 responses were obtained from 139 hospitals throughout Spain, which represents 53.5% of the IMUs in the SNHS. The mean number of internists per IMU was 14 ± 8, with a mean rate of 7.2 ± 3.3 internists per 100,000 inhabitants. In 2013, the average number of hospital discharges from the IMU was 2987 ± 2066, and those discharged by internists was 232 ± 107. Sixty-one percent of the IMUs had implemented an interconsultation unit, and 41% had implemented a systematic care program for complex chronic patients. Thirty-three percent of the IMUs conducted multidisciplinary rounds, and 60% of these IMUs planned the discharge. Conclusions The 2013 RECALMIN survey revealed a number of important aspects of the organization, structure and management of IMUs. The remarkable variability in the indicators of structure, activity and management probably reflect significant differences in efficiency and productivity, which therefore provide significant room for improvement.

Resumen Objetivos Elaborar un diagnostico de situacion sobre la asistencia en las unidades de medicina interna (UMI) en Espana y desarrollar, basandose en el analisis anterior, propuestas de mejora de calidad en dichas unidades. Material y metodos Estudio descriptivo transversal entre las UMI de hospitales generales de agudos del Sistema Nacional de Salud (SNS), con datos referidos a 2013. Las variables de estudio fueron recogidas mediante un cuestionario ad hoc. Resultados De un total de 260 hospitales identificados en el SNS espanol, se han obtenido 142 respuestas de 139 hospitales de toda Espana, que representan el 53,5% de las UMI del SNS. La media de internistas por UMI fue de 14 ± 8, siendo la tasa media de internistas por cada 100.000 habitantes de 7,2 ± 3,3. El promedio de altas hospitalarias de las UMI en 2013 fue de 2.987 ± 2.066 y las altas anuales por internista 232 ± 107. El 61% de las UMI ha desarrollado una unidad de interconsulta y el 41% un programa de atencion sistematica al paciente cronico complejo. En el 33% de las UMI se realiza un pase de visita multidisciplinar y un 60% de las mismas planifica el alta. Conclusiones La encuesta RECALMIN 2013 desvela aspectos relevantes sobre la organizacion, estructura y gestion de las UMI. La notable variabilidad hallada en los indicadores de estructura, actividad y gestion probablemente refleja diferencias notables en eficiencia y productividad y, por tanto, propicia un amplio margen de mejora.