Hospital-based emergency care: Italy and America in comparison


The purpose of this summary is to analyse the main problems of the hospital-based emergency care which are common to Italy and to the USA where hospital-based emergency is one the widely suited systems and usually occurs as a reference model.

The model of hospital-based emergency care in the USA is among one of the main reference models, also in Italy. However, it doesn’t appear to be so different from Italy.  As Aldina Gardellinia and Roberto Nardi point out, the American non-profit organisation IOM (Institute of Medicine) has conducted a through analysis of the Emergency Medical Service (hereinafter: EMS) during the last decade in the USA which resulted in the publication of the volume entitled “Hospital-Based Emergency Care: at the breaking point”. From this analysis, it follows that EMS in the USA, as in Italy, is characterised by a massive overcrowding of the emergency rooms in the hospitals. Moreover, this analysis underlines the increasing inflow of people to the emergency departments which have become, especially during the night and weekend when other doctors are not available. The “boarding” practice is also getting more and more common, under which patients are usually detained in the emergency departments with scarce security, privacy and a low availability of resources to guarantee the hospitalisation.

The solutions provided by this research emphasise the need to undergo different tests in order to improve EMS, which regard the modulation of the available resources. The development of a 24h Rapid Response Unit and an efficient coordination of the flow of patients through the figure of the “hospitalist” would solve the problem of  overcrowding.

Similarly, for what concerns the Italian health care policy, the main consideration regard:

– the increase of the resources in the emergency departments that may result insufficient and unproductive;

– the necessity that all the EMS staff should perceive the problems related to the Hospital-based emergency care;

– the need to develop a better coordination between the emergency departments and the other units.

Finally, it is of extreme importance, as already stated by Gardellini and Nardi, to develop tools of bed management which usually implies innovative solutions and the figure of a medical internist who could also perform the tasks of a hospitalist.

Note: This article is based on a summary of the article: Hospital-based emergency care: are we so different from America? By Haupt, Enrico & Flego, Gaddo & Gardellini, Aldina & Nardi, Roberto. (2013)


Haupt, Enrico & Flego, Gaddo & Gardellini, Aldina & Nardi, Roberto. (2013). Hospital-based emergency care: are we so different from America?. Italian Journal of Medicine. 3. 10.4081/itjm.2009.244.


Emergency Medical Service, Emergency Department, Hospital-based emergency care