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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].