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This study was conducted in the quick diagnosis unit of a public
tertiary university hospital
with 855 beds and a reference
population of 550,000 (Tertiary Unit) and the quick diagnosis unit of
a
second-level district hospital with 160 beds
(Secondary Unit), both in
Barcelona. The latter is the healthcare provider for a population of
140,000 inhabitants. Both units are integrated in the internal medicine
departments of their respective hospitals.
The structure, indications for referral, and operating procedures of
these units have been reported previously [6,10,14,15]. Briefly,
they work as ambulatory clinics evaluating patients with suspected
severe disorders whose general physical condition is acceptable enough
to enable them to go to hospital for investigations and appointments,
then back to home. The clinical indications for referral to both units
are the same. The general working protocol of both consists of a rapid
first appointment after referral from primary care centers or the
emergency departments of the hospitals (usually within 5 days), followed
by preferential programming of diagnostics tests and subsequent visits
until a diagnosis is made. Staff
at the unit of the tertiary
hospital includes a consultant general internist, a senior internal
medicine resident, nursing, and
administrative staff. The unit is
open 5 days a week [11,12]. In contrast, the
unit of the secondary hospital is
staffed with two part-time general internists as well as administrative
personnel [10,15].