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Resumen Desde la Antiguedad los medicos han necesitado, y solicitado, el apoyo y consejo de colegas experimentados. Esta practica fue refrendada por Hipocrates y Galeno, permaneciendo sin cambios hasta la Ilustracion. En ese periodo, la interconsulta alcanzo un gran auge. Se escribieron libros monograficos, se estudiaron las caracteristicas y cualidades que debia poseer el medico consultor y los problemas que podia originar, y se establecieron reglas y pautas a seguir durante su desarrollo. Esta situacion se mantuvo estable hasta finales del siglo xix , cuando la aparicion de diversas especialidades medicas ofrecio la posibilidad de buscar ayuda especializada. Esta especializacion origino una fragmentacion de la asistencia medica, lo que favorecio la aparicion del internista como «consultor universal». En el ultimo cuarto del siglo xx , ante la importancia y problemas de la interconsulta, se comienza a desarrollar su estudio, se crean servicios especializados en su resolucion y, finalmente, aparece la asistencia compartida.

Physicians have long needed and sought out the support and advice of experienced colleagues. This practice, endorse by Hippocrates and Galen, remaining unchanged until the Enlightenment. During that age, cross-consultations boomed. Monographic works were written, the characteristics and qualities that consulting physician had to possess were studied the problems that it could cause were examined, and rules and guidelines to follow during a cross-consultation were established. It remained unchanged until the end of the 19th century, when the emergence of various medical specialties offered the possibility of seeking specialized assistance. This specialization gave rise to a fragmentation of medical care which favored the emergence of the internist as a “universal consultant.” In the last quarter of the 20th century, in light of the importance of and problems arising from cross-consultation, it began to be studied on its own, specialized services were created to attend to them, and, finally, comanagement appeared.

Resumen La mayoria de los pacientes quirurgicos hospitalizados tiene mucha comorbilidad medica y recibe un gran numero de medicaciones, o sufre complicaciones importantes, o ambos. La asistencia compartida (AC) es la responsabilidad y autoridad compartidas en el manejo de un paciente hospitalizado. Se discute si se deben seleccionar o no pacientes para la AC. Los diferentes criterios de seleccion no son seguros o faciles de aplicar, y dejan fuera a muchos pacientes subsidiarios de AC. El manejo perioperatorio es fundamental para la mortalidad postoperatoria. El fallo del rescate (mortalidad hospitalaria secundaria a complicaciones posquirurgicas) es el principal factor sobre la mortalidad quirurgica hospitalaria. Afecta a cualquier paciente, independientemente de su edad, comorbilidad o tipo de cirugia. El componente que reduce mas el fallo de rescate es la presencia de internistas en las salas quirurgicas. Consideramos que todos los enfermos hospitalizados en los servicios quirurgicos deberian recibir AC.

Most hospitalized surgical patients have significant medical comorbidity and are treated with a considerable number of drugs and/or experience significant complications. Shared care (SC) is the shared responsibility and authority in managing hospitalized patients. In this article, we discuss whether patients should be selected for SC or not. The various selection criteria are not an exact science nor are they easy to apply. Furthermore, they may leave out many patients who may be good candidates for SC. Perioperative management is essential for preventing postoperative mortality. Failure to rescue (in-hospital mortality secondary to postoperative complications) is the main factor linked to in-hospital surgical mortality and can affect any patient regardless of age, comorbidity, or type of surgery. The component that most reduces failure to rescue is the presence of internists in surgical wards. We believe that all patients hospitalized in surgery departments should receive SC.

Scientific and technological advances are changing medical practice and transforming hospitals, and both the age and comorbidities of hospitalized patients are rapidly increasing. The increasing complexity of these patients and the scant clinical differences between medical and surgical inpatients calls for changes in the organization and delivery of in-hospital care. Our objective has been to assess differences in age and comorbidity between surgical and medical inpatients.Retrospective, observational, descriptive study in patients aged ≥16 years discharged from all medical and surgical services during 2019, except for obstetrics and intensive care. All data were obtained from the hospital's minimum basic data set and analyzed using univariate analysis.The study included 31,264 patients: 16,397 from the medical area and 14,867 from the surgical area. Those in the surgical area were 8 years younger (62.69 years [95% CI 62.4-62.98]), with a slightly higher proportion of women (OR 1.12 [95% CI 1.07-1.17]) compared to the medical area, and fewer non-scheduled admissions (OR 0.11 [95% CI 0.10-0.12]). There were no significant differences in comorbidity burden between study groups.Patients in the surgical area have a high burden of medical comorbidity, similar to those in the medical area. This information is important for surgeons and anesthetists, and should compel hospitals to change the current organizational model.

Resumen Objetivo Analizar la actividad de interconsulta (IC) realizada por los servicios de medicina interna (MI), sus aspectos formales, el perfil de la atencion clinica requerida y cuantificar la carga de trabajo que supone. Material y metodo Estudio multicentrico, observacional, prospectivo, sobre enfermos consecutivos hospitalizados atendidos por servicios de MI mediante IC entre el 15 de mayo y el 15 de junio del ano 2016. Se estimo la carga de trabajo relacionada con dicha actividad (1 UT = 10 min). Resultados Se registraron 1.141 IC procedentes de 43 hospitales, edad 69,4 (DE: 16,2) anos, 51,2% hombres. El indice de Charlson fue 2,3 (DE: 2,2). Los motivos de consulta mas frecuentes fueron: valoracion general (27,4%), fiebre (18,1%), disnea (13,6%), trastorno metabolico (9,6%), HTA (6,3%) y sindrome confusional (5,3%). Las UT estimadas fueron 4 (DE: 5,9) para la primera visita y 7,3 (DE: 21,5) para la suma de las sucesivas. Los pacientes quirurgicos fueron mayores (70,6 [DE: 15,9] vs 64,4 [DE: 16,3]; p = 0,0001) y precisaron mas dias de seguimiento (5 [DE: 7,3] vs 3,5 [DE: 4,2]; p = 0,009). Los siguientes aspectos fueron mas frecuentes en el formato de las IC realizadas por servicios medicos: numero de IC ordinarias (respuesta > 24 h), especificacion del motivo de IC, datos minimos referentes a la historia clinica y coincidencia de la adecuacion en el tiempo con el consultor. Conclusion Los pacientes atendidos mediante IC por los servicios de MI representan una carga de trabajo importante. La adecuacion al formato de solicitud de IC es mayor en las procedentes de servicios medicos.

Objective To analyze the activity of interconsultations conducted by internal medicine (IM) departments, their formal aspects and the profile of clinical care required and to quantify the workload they represent. Material and method A multicentre, observational prospective study was conducted with consecutive hospitalized patients treated by IM departments using interconsultations between May 15 and June 15, 2016. We estimated the workload related to this activity (1 time unit [TU] = 10 min). Results We recorded 1141 interconsultations from 43 hospitals. The mean age of the patients involved was 69.4 years (SD: 16.2), and 51.2% were men. The mean Charlson index was 2.3 (SD: 2.2). The most common reasons for the consultations were general assessments (27.4%), fever (18.1%), dyspnea (13.6%), metabolic disorder (9.6%), arterial hypertension (6.3%) and delirium (5.3%). The duration of the first visit was 4 TUs (SD: 5.9) and 7.3 (SD: 21.5) for the sum of all subsequent visits. The surgical patients were older (70.6 [SD, 15.9] vs. 64.4 [SD, 16.3] years; p = .0001) and required more follow-up time (5 [SD, 7.3] vs. 3.5 [SD, 4.2] days; p = .009). The following issues were more common in the interconsultation format performed by medical services: number of regular interconsultations (response >24 h), specification of the reason for the interconsultation, minimal data regarding the medical history and agreement on the appropriateness of the time spent with the consultant. Conclusion The patients treated through interconsultations by the IM departments represented a significant workload. The interconsultations from the medical departments were more in line with the request format.

Resumen Objetivo Conocer las caracteristicas de los pacientes con fibrilacion auricular (FA) en el ambito hospitalario y sus sucesivos ingresos. Metodo Estudio retrospectivo de cohortes con la totalidad de los ingresos hospitalarios en el area medica del hospital de Lugo entre el 1 de enero de 2000 y el 31 de diciembre de 2013. La fuente de informacion fue el conjunto minimo basico de datos del centro. Resultados Se registraron 149.271 ingresos hospitalarios correspondientes a 66.286 pacientes. Con respecto al total, el porcentaje de ingresos y pacientes con FA fue del 17,3% (25.870) y 18,9% (12.512), respectivamente. Los pacientes con FA se caracterizaron por una mayor proporcion de mujeres (49,7 frente a 44,3%; p Conclusiones La FA se presenta en pacientes de alta complejidad, ingresados mayoritariamente en servicios de Medicina Interna, y se asocia a una elevada tasa de reingresos. Es preciso considerar las enfermedades asociadas a la FA que permitan un enfoque global de estos pacientes.

Objective To determine the characteristics of patients with auricular fibrillation (AF) in the hospital setting and their successive hospitalisations. Method A retrospective cohort study was conducted on all hospital admissions in the medical area of hospital of Lugo between January 1, 2000 and December 31, 2013. The data source was the centre's minimum basic data set. Results A total of 149,271 hospital admissions corresponding to 66,286 patients were recorded. Of the total, the percentage of admissions and patients with AF was 17.3% (25,870) and 18.9% (12,512), respectively. The patients with AF were characterized by a larger proportion of women (49.7 vs. 44.3%; p Conclusions AF occurs in highly complex patients, who are mostly hospitalized in internal medicine departments, and is associated with a high rate of readmissions. We need to consider the diseases associated with AF for an overall approach to these patients.

Most hospitalised surgical patients have significant medical comorbidity and are administered a considerable number of drugs and/or experience significant complications. Shared care (SC) is the shared responsibility and authority in managing hospitalised patients. In this article, we discuss whether patients should be selected for SC. The various selection criteria are not safe or easy to implement and leave out many patients who are eligible for SC. Perioperative management is essential for preventing postoperative mortality. Rescue failure (hospital mortality secondary to postoperative complications) is the main factor linked to hospital operative mortality and can affect any patient, regardless of age, comorbidity or type of surgery. The component that most reduces rescue failure is the presence of internists in operation rooms. We consider that all patients hospitalised in surgery departments should receive SC.

To determine the characteristics of patients with auricular fibrillation (AF) in the hospital setting and their successive hospitalisations.A retrospective cohort study was conducted on all hospital admissions in the medical area of hospital of Lugo between January 1, 2000 and December 31, 2013. The data source was the centre's minimum basic data set.A total of 149,271 hospital admissions corresponding to 66,286 patients were recorded. Of the total, the percentage of admissions and patients with AF was 17.3% (25,870) and 18.9% (12,512), respectively. The patients with AF were characterized by a larger proportion of women (49.7 vs. 44.3%; P.0001), advanced age (78.3 [DE 10.2] vs. 67.1 years [DE 17.9]; P.0001), more chronic diseases (4.2 [DE 2.1] vs. 2.9 [DE 1.9]; P.001), longer hospital stays (12.5 [DE 12.5] vs. 10.6 [DE 19.9] days; P.0001) and a high rate of readmissions (3.0 [DE 2.75] vs. 2.1 [DE 2.28]; P.001), with a progressive shortening of the time between hospitalisations. The department of internal medicine was responsible for the care of more than half of the patients with AF. The most common associated secondary diagnoses were chronic obstructive pulmonary disease, stroke, heart failure, ischemic heart disease, other respiratory system diseases and arterial hypertension.AF occurs in highly complex patients, who are mostly hospitalized in internal medicine departments, and is associated with a high rate of readmissions. We need to consider the diseases associated with AF for an overall approach to these patients.