In the emergency room of the “Morgagni-Pierantoni” hospital in Forlì we work daily on two parallel paths: assisting patients potentially positive to covid-19 on the one hand and on the other to take care of patients with other pathologies. An organizational and complex situation that makes daily activities more complicated, to which is added the lack of doctors which translates into supernumerary shifts compared to those foreseen. To make the point is Dr. Andrea Fabbri, director of the Emergency Department, Emergency Medicine and 118 Unit of the Forlì hospital and director of the Simeu Study Center (Italian Society of Emergency-Urgency Medicine)
Doctor Fabbri, with the growth of infections in recent weeks, how is the situation in the emergency room evolving?
The number of accesses has returned to that of the pre-covid era, sometimes with a typology of requests that also includes non-urgent problems. The number of suspected cases in the last two weeks has increased, also due to the increase in cases with seasonal fever. In the context of suspected cases, about 5-7 a day are Covid positive. However, the hospitalized cases are predominantly not vaccinated as an alternative with a serious risk profile due to the number of chronic diseases and frailty.
Do they show up only old people, or also young people?
The unvaccinated cases that go to the emergency room are mainly young people, but there are also elderly people who for different reasons are not vaccinated
The emergency room, in addition to being crowded again, has to deal with a more complex management: how is patient access managed? Are there any overcrowding in the waiting room?
The waiting room is managed to the best of safety criteria and regulations in force: by overcrowding we mean an excessive number of patients in the care of the organization and not an overcrowding of spaces and environments. The paths of the users are managed by different paths both in terms of diagnostic complexity and of assistance resources. Having to give appropriate and safe answers, we register a considerable difficulty which translates into prolongation of both waiting times for the visit and users’ stay.
Among the unvaccinated who arrived in the emergency room, there have been cases of riotous, skeptical subjects, is there anyone who has denied consent to hospitalization recommended by the doctors?
I am not aware of any cases of this type
There is not only the covid. The normal seasonal flu also worsens the situation, which last year practically ‘disappeared’. What are the main pathologies?
Contrary to the period February – May 2019, the type of pathologies is similar to the previous one, including non-urgent ones.
The director of the hospital, Paolo Masperi, in ForlìToday explained that “the persistence of the Covid emergency is really physically and psychologically trying all the staff“What repercussions are there or can there be on first aid activities?
The extreme difficulty of doctors, nurses, oss, stretcher bearers, emergency room drivers, emergency medicine and 118 is represented by the number of additional shifts, holidays, night shifts, sick days, resignations and leave, and episodes of violence suffered that determine a stress and pressure that day after day is wearing down the system to the point of putting a strain on the response to citizens, a response that translates to the emergency room in increasingly prolonged waiting, stay and hospitalization times.
Is there also the problem of a shortage of doctors and emergency-urgency workers in Forlì?
The shortage in particular concerns doctors who, as is now known, also in the national field reaches about 30% of the total staff. This translates into extra shifts compared to those foreseen, at a number of 6 nights per month, almost all busy weekends, reduction of vacation days and excess hours recovered. In this context a doctor is working for at least 2.
The holiday season is approaching. What can we expect?
If it has been difficult up to now, I believe that the Christmas holiday period will be very difficult, also in relation to the reduction of the response of both hospital and territorial services, in particular on holidays, as opposed to what concerns our service which must respond. to all requests 24 hours a day Christmas, New Year included.
Do you want to make an appeal to citizens?
Awareness of the emergency room, which in particular in this period has become a real shock absorber for all the non-responses of the local and hospital services. To defend and protect the emergency-urgency response, a great sense of responsibility is asked of citizens in contacting the emergency room for strictly necessary problems, delegating their own doctor or medical guard for all problems that can find a deferrable solution.