Hospital organization: general internal medical and geriatrics wards.

To the Editor: The provision of care for nonsurgical patients in the hospital has been largely debated in recent years. We would like to contribute to the discussion concerning the future of hospital medical wards in the context of the demographic challenge to health care systems due to the progressive aging of the population and of the changes induced by technology (both diagnostic and surgical). In this context, an important debate is ongoing regarding the number and organization of beds for patients affected by nonsurgical problems. The focus should be placed on the needs of different categories of patients, i.e., on one end of the spectrum, young patients with acute medical problems and, on the other, old patients who are chronically and/or critically ill. In Table 1 we report mean age, length of hospital stay, Diagnoses Related Group (DRG) weight, and Charlson Index of patients consecutively admitted between January 1, 2004 and June 30, 2004 to a geriatric ward (24 beds) with a fourbed Sub Intensive Care Unit (SICU) (in which severely ill elderly patients requiring frequent, but usually not invasive, monitoring of vital signs and/or intensive interventions, are admitted) and to a general internal medical ward (38 beds). The patients were classified according to age (.65 years old or 65 years old) in our 350-bed hospital (Poliambulanza Hospital, Brescia, Italy). Most patients (82%) are admitted through the Emergency department. Data reported in the table warrant comment: