The “serious and unresolved issue of ‘massive’ congestion in emergency rooms”, encountered “daily” and “for years”, requires full “awareness” at “all decision-making levels” of the fact that these facilities are visited, “at any time of the day or night, by citizens who in at least 75% of cases have health problems that can and must be managed elsewhere, more specifically at the level of community medicine”. This was underlined by Mario Balzanelli, national president of Sis 118, announcing that a conference organized by the ASL of Taranto on October 17 and 18 will be dedicated to the topic, which will allow “to start from the analysis of the current critical issues to formulate proposals for new organizational models of an integrated system of emergency-urgency medicine, at the territorial and hospital level, with community medicine”.
The “situation of perennial overcrowding in emergency rooms requires, with the utmost urgency, that a solution be adopted to optimize flow, and therefore decongestion, at two levels, organizational and management, placed, respectively, upstream of the emergency rooms and downstream of these structures”, says Balzanelli. Upstream “the new strategic articulations of territorial medicine established by Ministerial Decree 77 can make use of the activity of the First Aid Points (Ppi) of the Territorial Emergency System 118, as strategic intermediate structures on the territory, advanced medical-nursing rescue stations capable of managing with a first intervention, carried out immediately and characterized by high appropriateness of performance, any acute clinical situation, whether it is an emergency, urgency or minor acuity”.
In this vision, the 118 First Aid Points can be considered, in areas far from hospitals, but also in urban areas. In addition, “at the Health Houses or Community Hospitals, the Ppi could ensure immediate rescue intervention, in case of emergencies or urgencies, for patients who are inside these structures”. To confirm his assessments, Balzanelli reports the data of some activities of the First Aid Points of the ASL of Taranto, in the period between 2016 and 2023. A total of 352,231 accesses were recorded; 14,099 patients, or 3.76% of all accesses, were transferred to the emergency rooms of the province of Taranto; 833 patients (0.24% of all accesses) were admitted to the hospital operating units of the Moscati of Taranto; 337,299 patients, or 96% of all accesses, were visited, treated and sent home. In the same Ppi, 141 red codes were managed, again in the reference period 2016-2023 (4% of all accesses).
From the data cited, Balzanelli comments, “it is clear that all patients with acute conditions were initially managed appropriately; no criminal convictions were recorded with respect to patients visited, treated and sent home; a filtering action was highlighted, and therefore a concrete decongestion, with respect to provincial emergency rooms”.
As regards the activities downstream of the emergency rooms, “and more precisely downstream of the Intensive Short Observations, the emergency medicine operational units must be significantly strengthened in each province, for the appropriate management of unstable patients, pending the definition of the clinical conditions that may allow transfer to another operational unit, hospital or territorial (for example community hospital), or, alternatively, discharge to home”.
For Balzanelli, today it is urgent to “decide on the need to create a ‘systemic’ organizational model in healthcare that finally sees the primary care system functionally integrated with the emergency system and at the same time with the hospital system, respecting their respective – peculiar and non-overlapping – skills and management autonomy, fully centered on the specific care needs of the person, able to ensure, with shared strategic paths, fast, effective, efficient and appropriate operations for any acute health problem, whether it can be classified as an emergency, urgency or minor acuteness”.
#Balzanelli #Sis #Emergency #rooms #perpetually #overcrowded #cases #managed
