“Emergency-urgency is one of the main sectors of activity of the discipline of anesthetists-resuscitators which needs extensive reorganization”. This was said by the president of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (Siaarti), Antonino Giarratano, in his speech today in the Chamber for the presentation of the conclusions of the fact-finding investigation on the emergency-urgency system of the Social Affairs Commission of the Chamber .
“Beyond the critical issues related to the shortage of doctors and the need to have new resources and to implement the number of beds in some sectors – points out Giarratano – it is essential to intervene with a reorganization of the entire critical and emergency area – urgency, which concerns both the hospital and the territory”. In this sense, the project for the revision of Ministerial Decree 70 (hospital) and integration with Ministerial Decree 77 (territory) can only pass through a reform that the president of Siaarti prefers to define as “reorganization of the emergency system and critical/intensive area, which must take place simultaneously both in the local area and in the hospital setting”. “It is the patient and good clinical practice that guide the taste traveled from the territory to the hospital and from the hospital to the territory”, he underlines.
“As already reported months ago by Siaarti at the technical table of the ministry and reiterated during the hearing on the situation of emergency medicine and first aid in Italy promoted by the XXII Commission (Social Affairs) of the Chamber of Deputies, chaired by Honorable Cappellacci – recalls Giarratano – the reform of Ministerial Decree 70 and System 118 should therefore aim at an adequate and clear redefinition of the logic of levels of intensity of care, definitively indicating the requirements that define the characteristics: of the Intensive Care Units of the departments; high intensity of care of the exclusive competence of the anesthetists-resuscitators; of the sub-intensive care units”.
According to President Siaarti “a rationalization of access to the hospital emergency-urgency network through the emergency and local emergency room must also be envisaged, with a reorganization and redefinition of the path of the acute patient”. The intra-hospital emergency (polytrauma, septic shock, acute multi-organ failure, emergency surgeries from general to specialist, time-dependent network pathologies, etc.), “which is not disconnected from the extra-hospital emergency, representing a unicum in the path of the acute patient from the territory to the hospital, it is and remains in the competence of the anesthesiologist-resuscitation specialists, who already share the path with the specialist hospital operating units necessary for its treatment”, adds Giarratano.
From these observations it can be deduced how the application of the Siaarti proposal “could achieve multiple objectives which, today, often remain fragmented in ‘separate compartment’ reform projects (territory, hospital, 118). The hospital reorganization of sub-intensive and intensive areas proposal and the reform of the 118 system which integrates with that of the territorial operations center system – Giarratano is convinced – should direct the patient towards the structure, territorial or hospital, which can treat him with the right skills and in the right times, resolving overcrowding of the emergency room and entrusting the emergency to the emergency specialists and the deferrable and specialist emergency to the specialists of the various disciplines”.
“The average data says that in all regional health services the respective 118 systems certify only 5-7% of calls as emergencies, while the remaining 93-95% of patients could be treated according to a new organizational model that integrates the territorial structures with hospital ones”, remarks Giarratano, basing his reasoning on well-known evidence: in the three-year period 2017-2020 the average figure of improper access to the emergency room exceeded 22%, “resulting in overcrowding in the emergency areas and emergency room also where there are no shortages of staff and hospital beds which, however, can be considered factors not to be underestimated where they are present”.
This evidence “confirms the need for the reorganization proposed by Siaarti – continues the president – which would distinguish emergencies from deferrable urgencies or, worse, from normal conditions which, upon arriving at the emergency room, are defined as white and green codes. In emergencies, with these limited percentages, there would be resources for specialists who have the skills to intervene (doctor with specialization in anesthesia and resuscitation and/or emergency medicine) and who should be professionally classified with specific contractual provisions that take into account the peculiarity and burdensomeness of the activity carried out in this sector”.
“In this sense – concludes Giarratano – a reform of access to degree courses in Medicine must also go hand in hand, integrated however with that of post-graduate specialization courses, which must guarantee the right and non-deferrable training in the field (territory and hospital), but in a university training context that certifies it as complete (which is not always achievable if doctors in training are destined to cover ‘staffing gaps’ in hospitals without the specialties necessary to train them). more true in areas such as the emergency and critical area where the protection of the quality of training makes the difference between life and death”.
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