Being quick in the first intervention can mean saving a life, especially when you are affected by pathologies such as heart attacks and strokes. For this reason, the so-called time-dependent networks, from the cardiological one to the emergency-urgent one, are crucial: on this front, Italy presents strong differences between the regions, with the North confirming itself as ‘faster’, with better performances in putting responses are underway in the first hours after the onset of symptoms, and the South and inland areas often struggle, as in the case of Campania which is last in terms of emergency room (ED) services.
Video Stroke, heart and emergencies there is a gap between Regions
However, it is precisely the PSs that represent the thorn in the side of various Regions, with long waiting times which are among the causes of the phenomenon of ‘abandonment’: that is, people go to emergency-urgency points and then leave even before having carried out the medical examination. It is a complex picture that emerges from the third ‘National survey on the state of implementation of time-dependent networks’ by Agenas, presented today. The survey is conducted in 2023 by analyzing the monitoring results compared to the year 2022. The snapshot of the four main time-dependent networks (cardiological, stroke, trauma, urgent emergency) was obtained on the basis of a questionnaire compiled by the Regions and the evaluation of a series of indicators: from the proportion of heart attacks treated with angioplasty within 90 minutes of admission to 30-day mortality, from the total number of hospitalizations and length of stay in the emergency department to the percentage of abandonment of these departments. In particular, as regards the Cardiology Network, the survey finds that the Network “suffers in those more internal and less served areas”.
It works best in three regions: Lazio, Liguria and Marche. Good performances also in 5 other Regions (Emilia Romagna, Piedmont, Puglia, Tuscany and Veneto). The worst performances are recorded in Abruzzo and Calabria, followed by Valle d’Aosta and Molise. The autonomous Province of Trento is then at the top of the ranking for the percentage of heart attacks treated with Coronary Angioplasty within 90 minutes of hospitalization, as required by the standards set by ministerial decree 70/2015. In the PA of Trento, in fact, the rate of heart attacks treated according to this standard is 62.35%. The worst percentages are recorded in Basilicata (34.48%), Liguria (39.41%) and Sicily (42.82%). For the stroke network, the worst are Sardinia and Abruzzo and the best are Emilia Romagna, Lazio, Liguria, Marche but also Campania. The highest 30-day mortality due to stroke is recorded in Basilicata, the lowest in Umbria (7.63%). The Emergency-urgency (PS) network works well in various Northern Regions: the first in terms of assistance and care is the autonomous province of Bolzano; positive results also in Veneto and Lombardy.
Worse performances, however, especially in the South such as Sardinia and especially Campania, which comes last, but critical issues also exist in Valle d’Aosta. Compared to the percentage of hospitalizations from emergency departments, 13 Regions exceed the national average of 12.79% and Puglia stands at 18%. As for waiting times, the most virtuous is Valle d’Aosta with a median time between the arrival and hospitalization of patients of 88.5 minutes, the worst is Lazio with 305 minutes. The Regions with the highest percentage of abandonment of the PS are Campania (11.80%), Sardinia (24.31%) and Sicily (12.71%), compared to a national average of 6.29%. Those with the lowest abandonment percentage are Valle d’Aosta with 0%, Basilicata (1.30%) and Veneto (1.65%). There are various reasons for the performance gap between the regions, but also, explained Francesco Saverio Mennini, head of the Planning Department of the Ministry of Health, “the lack of a national health plan since 2006; in the absence of such a plan it is difficult to plan correctly in the healthcare sector also for the purposes of implementing time-dependent networks”. These data, concluded the director of the Agenas Health Area Department, Antonio Fortino, “are not just numbers, but there are people and patients behind them. Behind this work, which we will continue, there is also a strong ethical drive”.
Bolzano, Emilia Romagna and Liguria in the lead for stroke assistance
Compared to the time-dependent network for stroke, one of the parameters evaluated in the survey is mortality 30 days after hospitalization. Positive performances are recorded in the autonomous province of Bolzano, Emilia-Romagna and Liguria. The last places are occupied by Valle d’Aosta, Molise and Basilicata.
There are various reasons for the performance gap between the regions, but it also weighs heavily, explained Francesco Saverio Mennini, Head of the Department of Programming, Medical Devices, Medicines and Policies in favor of the National Health Service of the Ministry of Health, “the lack there has been no national health plan since 2006; in the absence of such a plan it is difficult to plan correctly in the health sector”. This, he underlined, “is among the objectives of the ministry that we will carry forward and is also necessary for the implementation of time-dependent networks”.
Precisely in time-dependent networks, added Mennini, “it is crucial to quickly take care of the patient in his own territory. The survey reveals significant variations between the various regions and within them, and these disparities are also linked to the different models organizational, so we will need to move towards greater homogeneity”.
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