The investigation by the Social Affairs Commission of the Chamber on the emergency-urgency in Italy and the emergency room situation photographs “a difficult situation, which today in Italy represents the ‘tip of the iceberg’ and the consequence of complex, often inveterate, problems connected to each other”, among the causes “the lack of 4,500 doctors and 10 thousand nurses, the waiting times for hospitalization (boarding), the lack of beds available in the inpatient departments caused and the difficulty in ensuring an adequate turnover of people”. Access to the emergency room, according to the survey, “has reached very high numbers, which according to some estimates should exceed 20 million per year, with an increase in certain periods, linked to the seasonality of epidemiological factors and the mobility of the population (flu period and holiday and tourism periods”. Furthermore, “the high number of improper accesses was found: numerous they are the patients who self-present themselves at the emergency room; the number of ‘green codes’ and ‘white codes’ well exceeds 50% of total accesses“.
The conclusions of the Commission, after having listened to all representatives of the sector in the hearings, from scientific societies to trade unions, were collected in a final document approved yesterday, and indicate several points on which to intervene: the strengthening of local medicine; greater availability of beds; reduction of waiting lists; reorganization of the emergency-urgency system; staff development; protection of healthcare personnel; promotion of the dissemination of correct information among the population.
The solutions
Here are the solutions identified:
1) Strengthening of local medicine. At the conclusion of the investigation, “there seems to be no doubt that, if we want to try to resolve the problematic situation in which emergency medicine currently finds itself, it is essential to carry out a real reform of the system as a whole, strengthening local medicine. Only by acting in this direction could health requests not characterized by actual urgency be intercepted, which are currently inappropriately concentrated on the emergency room, with serious consequences in terms of overcrowding”.
2) Greater availability of beds. “From the reorganization of local medicine, from the development of intermediate structures for low-intensity care, from greater hospital-territory integration, a greater availability of hospital beds and the turnover of the latter should result. In fact, it is necessary to decongest the emergency room both incoming and outgoing assistance, through the appropriate allocation of low priorities, on the one hand, and ensuring high intensity care for patients who need it, on the other. The correct approach to the problem, therefore, passes through both the provision of resources and through the remodulation of organizational models”.
3) Reduction of waiting lists. “The problem of waiting lists represents one of the main causes of overcrowding in emergency rooms. It is therefore necessary to identify a solution aimed at addressing the problem in an organic way. In this sense, in addition to the provisions contained in the Budget Law for 2024 , which provide for the increase in hourly rates for all additional services carried out by medical and health sector personnel from 2024 to 2026 as well as the provision for which the regions can use a quota not exceeding 0.4% of the level of indistinct financing of the standard national healthcare requirement to which the State contributes for the year 2024 for the recovery of the waiting lists, the Technical Table for the development and operation of the national Government Plan for the waiting lists has been established at the Ministry of Health waiting period 2024-26, with the main objective of radically innovating the tools for monitoring waiting times in order to make them increasingly timely and precise, and readily available for programming”.
4) Reorganization of the emergency-urgency system. It is also necessary to act at the level of organizational models, in order to make the emergency system more efficient. “Moreover, the need to proceed with the revision of ministerial decree no. 70 of 2015 has been raised by many parties, in order to fully achieve the integration of the emergency network into the hospital network. Among the measures that cannot be postponed , the implementation of alternative paths for the management and treatment of situations classifiable as ‘minor emergencies’ has been identified, such as ‘see and treat’ nursing management paths and ‘fast track’ early management paths, which can be activated for codes of low and medium healthcare complexity. The uniform application throughout the national territory of the single number for emergencies 112, which includes, among others, the number 118, also appears to be of primary importance.
5) Staff development. “There is no indicated solution that does not involve exceeding the spending ceilings to allow the recruitment of new healthcare personnel. As regards specifically emergency medicine, the problem also seems to be linked to the lack of attractiveness of the sector, for reasons that have been highlighted several times. One of the tools considered suitable for attracting healthcare personnel to this sector is the provision of incentives, not only economic ones”.
6) Protection of healthcare personnel. “The need to protect healthcare personnel working in the field of emergency medicine against physical and verbal aggression, which particularly affects this category of healthcare professionals, has been raised by many parties on the one hand “.
7) Promotion of the dissemination of correct information among the population. “One aspect of the problem is considered to be the lack of a health culture, whereby citizens are unable to evaluate their needs, especially with regards to access to the emergency system, failing to distinguish a need for health care urgent by a symptom that can be addressed in general medicine”.
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