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Vol. 7. Issue 6.
Pages 421-422 (November - December 2011)
Vol. 7. Issue 6.
Pages 421-422 (November - December 2011)
Letter to the Editor
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Introduction of a Day-Care Hospital Model: Proposals for Measures That Guarantee the Specific Needs of Rheumatology Services in the Community of Valencia (Spain)
Implantación de un modelo de hospital de día: propuesta de medidas que garanticen las necesidades específicas de los servicios de reumatología de la Comunidad Valenciana (España)
José A. Román Ivorraa,??
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Corresponding author.
, José Rosas Gómez-Salazarb, Javier Calvo Catalác, Grupo para el estudio de los hospitales de día de reumatología de la Sociedad Valenciana de Reumatología
a Servicio de Reumatología, Hospital Universitario La Fe, Valencia, Spain
b Servicio de Reumatología, Hospital de la Marina Baixa de Villajoyosa, Villajoyosa, Alicante, Spain
c Servicio de Reumatología y Metabolismo Óseo, Hospital General Universitario de Valencia, Valencia, Spain
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Tables (1)
Table 1. Main Deficits in the Current Valencia Rheumatology HD Model and Proposals for Improvement.
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Dear Editor:

Day hospitalization (DH) is medical or nursing medical attention for patients who require, during the same day, the application of treatments or diagnostic techniques that, without the existence of these centers, would require hospitalization. Day hospitals offer the same services available in a hospital to patients who need chronic treatment or biological therapy for rheumatic diseases, but without the need for their internment. This alternative reduces both the inherent risks of hospitalization to the patient as well as the costs of health assistance associated to treatment and hospitalization.1

The motive of this letter is to describe a series of recommendations used to unify Rheumatology Day Hospitals of the Comunidad Valenciana. Currently, the scenario in which the Rheumatology Day Hospitals of the Comunidad Valenciana (Spain) is one of absence of legislation and rules that regulate the activities performed there or that establish a model of reference to which every hospital must adapt. This fact has generated an elevated variability between different DH in this community, analyzed by Román et al.2

A meeting of 12 rheumatologists and one nurse was organized in Valencia, representing 11 hospitals in the Comunidad Valenciana (in Alicante, Hospital Clínico de San Juan, Hospital General de Elda, Hospital General Universitario de Alicante, Hospital de la Marina Baixa de Villajoyosa, Hospital General Universitario de Elche; in Castellón, Hospital General de Castellón, and in Valencia, Hospital Infantil La Fe, Hospital Universitario La Fe, Hospital Universitario Dr. Peset, Hospital General Universitario de Valencia and the Hospital Clínico Universitario de Valencia) in order to collect proposals for a new DH model, moderated by structured brainstorming.3 From these proposals and the analysis of the current models deficiencies,2 a work frame for proposing recommendations to improve and unify the current DH model of the Comunidad Valenciana, as other documents or specialties recommend on a national level.4,5

There are established recommendations centered on resources (defining needs and competences of the rheumatologist, pharmacist and nursing staff), procedures (such as protocols, questionnaires, schedules and DH circuits, integral attention and telephone consultations) as well as quality-related aspects that include the rheumatologist in the DH management process.

We recommend adapting both material and human resources, anticipating an increase in patients receiving treatment for rheumatic diseases. Acting protocols should be developed for all DH processes (allowing for a better control of those patients treated in DH and a better functioning of the center6), elaborate satisfaction and quality of life questionnaires, improve the centers circuits, increase patient attention hours, perform integral attention, etc. To improve quality-related aspects and the service offered to patients, we recommend integrating the rheumatologist in the processes of the Day Hospital. An implantation plan for the recommendations and the establishment of recommendations and the establishment of indicators allow the evaluation of the improvements introduced.

The main deficiencies of the current model and proposals for improvement are summarized in Table 1.

Table 1.

Main Deficits in the Current Valencia Rheumatology HD Model and Proposals for Improvement.

Main Deficits of the Current Model  Proposals for Improvement 
Unification of the Rheumatology DH with other specialties DH  Integration of Rheumatology in the DH management: creation of a multidisciplinary management commission or creation of monographic DH with associated specialties 
Poor accessibility to the patient in some aspects:  Measures: 
Part time schedules (only mornings)  Widen scheduled hours (full time) according to requirements 
Little time for rheumatology  Increase time dedicated to rheumatic disease treatments 
Scarce resources and space  Increase spaces dedicated to rheumatology 
Scarce human resources  Increase in DH personnel 
No complementary testing (except laboratory) at the center  Performance of complementary tests in the DH 
No integrated visits  Performance of integrated visits 
Delay in dispensing treatments by the pharmacist  Optimization of current processes and evaluation in the preparation of DH treatments 
Lack of rheumatology specialized nursing  Specialized rheumatology nurses 
Lack of rheumatology specialized burses  Nursing formation: offline and online courses, clinical sessions, seminars, workshops, etc. 
Little health education for the patient  Health education (books, pamphlets, triptychs, etc.) 
Lack of a contact telephone line  Provide contact numbers for the patient and assign a specific nurse for its attention 
Scarce process protocol  Creation of multidisciplinary workshops for dissemination, review and updating of protocols 
Few clinical sessions  Concrete dates (weekly or biweekly) for multidisciplinary and specific clinical sessions on biologic treatments 
Lack of DH results evaluation  Evaluation questionnaires for DH internal processes 
Lack of patient satisfaction and quality of life questionnaires  Elaboration of patient satisfaction and quality of life questionnaires 
Little discharge information  Elaboration of discharge referral notes 
Lack of internal communication between the personnel attending the patients in the DH and the department of rheumatology  Coordination of the functions of all of the personnel involved in the attention of rheumatology patients 
  Dependence on the part of the rheumatology nursing staff 
Lack of a responsible attending rheumatologist and physician at the DH  Creation of the figure of attending rheumatologist and Physician 
Lack of medical supervision before and after treatments administration  Before and after supervision of treatments on the part of a rheumatologist 

We believe it is relevant to consider these recommendations, because other studies7 suggest the importance of evaluating the function of the DH to plan strategies that permit the increasing use of these centers.

Finally, this study only shows those measures for the DH of the Comunidad Valenciana but we believe that these measures are applicable in DH in all of Spain (with prior studies to determine the situation of the Spanish DH and then adapt the measures proposed in this study).

Conflict of Interest

The study was carried out with the support of an unrestricted grant provided by Roche Farma, S.A.


We thank Andreu Covas Estruga and Verónica Albert Sánchez, of Gestió Organització Comunicació, S.A., for their support in the conduction of the methodology used for the elaboration of the study.

Annex 1

Miguel Belmonte Serrano, Francisco Javier Navarro Blasco, Inmaculada Calvo Penadés, Emma Beltrán Catalán, Esteban Salas Heredia, Paloma Vela Casasempere, Jenny De la Torre, Vega Jovani Casano, Juan José García Borrás and Juan Ramón Corts Giner.

J.A. Román, C. Chalmeta, G. Salvador.
Estado actual de los hospitales de día de reumatología en España.
Rev Esp Reumatol, 31 (2004), pp. 87-94
J.A. Román, J.R. Gómez-Salazar, J. Calvo, Grupo para el estudio de los hospitales de día de Reumatología de la Sociedad Valenciana de Reumatología.
Estado actual de los hospitales de día donde se administran los tratamientos de reumatología en la Comunidad Valenciana.
Reumatol Clin, 6 (2010), pp. 244-249
Unicef. Visualization in participatory programmes. A manual for facilitators and trainers involved in participatory group events. Bangladesh; 1993.
Sociedad Española de Oncología Médica (SEOM).
Hospitales de día: Recomendaciones según consenso nacional SEOM Madrid Marzo 2006.
Primer libro blanco de la Oncología Médica en España, Dispublic, SL, (2006),
Grupo de Trabajo para la elaboración de «Estándares y recomendaciones de HdD».
Unidad de Hospital de Día. Estándares y recomendaciones.
Ministerio de Sanidad y Consumo, (2008),
I. Delli-Gatti, F. Girelli, M. Scaramelli, G. Menegale, F. Trotta.
A rheumatologic day-hospital: analysis of a five-year activity. Divisione di rheumatologia. Azienza ospedaliera s. Anna, Ferrara.
Reumatismo, 48 (1996), pp. 123-128
A.P. Cairns, S.A. Wright, J.D. Patton, E. Campalani, A.J. Taggart.
Rheumatology day care and the impact of biological therapies-the belfast experience.
Rheumatology (Oxford), 41 (2002), pp. 356-367

En el anexo se relacionan los integrantes del Grupo para el estudio de los hospitales de día de reumatología de la Sociedad Valenciana de Reumatología.

Please cite this article as: Román Ivorra JA, et al. Implantación de un modelo de hospital de día: propuesta de medidas que garanticen las necesidades específicas de los servicios de reumatología de la Comunidad Valenciana (España). Reumatol Clin. 2011;7(6):421–22.

Copyright © 2011. Elsevier España, S.L.. All rights reserved
Reumatología Clínica (English Edition)

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