by Chiara Rivetti and Pierino Di Silverio
Just like for the boarding in airports, even emergency rooms are now the rule: especially in hub hospitals, it has become a serious and daily reality. The initiatives to manage it were limited to official documents that define its perimeter and maximum duration, set at 6 hours. But most patients don’t wait 6 hours, but 2 to 5 days or more. What solutions?
05 DIC –
The patient’s expectation of a bed in the ward after the hospitalization decision has been elevated to the dignity of a name, so frequent is it: boarding.
And exactly as for the boarding in airports, even emergency rooms are now the rule: especially in hub hospitals, it has become a serious and daily reality.
The initiatives to manage it were limited to official documents that define its perimeter and maximum duration, set at 6 hours. But most patients don’t wait 6 hours, but 2 to 5 days or more.
Il boarding certainly it shouldn’t simply be moved, and then fell back on the hospital doctors, because all departments complain of serious staff shortages or real burnout situations.
The actions to make these 6 hours written on paper become real are simple but not free of charge and Anaao Assomed has been proposing them for some time: we need more acute care beds, more long-term care beds, more doctors, more territory.
Il Boarding it is a consequence of the cuts in recent years and these cuts need to be remedied:
- Cutting Beds for acute and long-term care. In Italy from 2010 to 2020 they were 30,492 beds for acute patients were cut, with a reduction of 19%. The greatest cuts concerned Molise, Calabria, Puglia, Liguria, Regions in which more than 1 bed out of 4 was cut. But the heaviest cut, again between 2010 and 2020, concerned the long-term care, where there has been a national average decrease in bed places that nearly 30%.
Some Italian regions have cut more long-term care beds than the national average: Puglia (-69%), Lombardy (-54%), Piedmont (-48%), Lazio (-36%), Veneto (-36%) , Emilia Romagna (-31%).
Considering the total beds, calculated per 1,000 inhabitants, it can be seen that in 2010 there were a total of 4 beds available, while in 2020 this share decreased by 3.5 beds per 1,000 inhabitants. - Bed occupancy. Most of the patients on boarding are represented by elderly people with medical pathologies IThe occupancy rate of beds in medical departments is 97.6% It should be remembered that the optimal rate, to avoid increased mortality and morbidity, is considered not exceeding 85%, even if imprudently increased to 90% by Ministerial Decree n° 70/2015 on hospital standards.
- Long term Care (LTC) – Comparison with Europe
Spending on LTC has experienced the fastest growth in recent years, compared to other areas of health care. According to the OECD, factors such as the aging of the population and the increase in incomes which bring with it a higher expectation of quality of life among the elderly, have required an increase in expenditure on LTC. Looking at expenditure per inhabitant over the last 8 years, there have been countries that have significantly increased expenditure on LTC. Germany: +65%, Ireland: +39%, France: +24%, Austria: +21%. Italy has increased its spending on LTC by 10%, but continues to rank below the European average and with values that are well below those declared by Germany, France and Austria.
In 2020, Italy spent €274 per inhabitant on LTC, against a European average of €541. Germany spent €1,019 per inhabitant, France €689.
If we compare the LTC expenditure of European countries calculated with respect to the GDP, also in this case Italy is below the European average. Italy spends 0.98% of its GDP on LTC, against a European average which is almost double this value (1.81%).
Also with regard to LTC workers, typically nurses and OSS who provide care at home or in residential facilities, excluding hospitals, Italy ranks below the OECD average (5.2) with a rate of 3.7 per 1000 inhabitants.
- Improper access. In 2019 the white codes in the Italian PS are were 13% of the total. green codes accounted for 57%. The white codes, and certainly also a part of the green ones, should not go to PS and would require a different, territorial management. But the much-vaunted territorial reform is at a standstill, and the PNRR is proving to be just a building operation.
- Doctors are missing. The number of doctors peaked in 2009, then declined steadily until 2020, shrinking by 4,800 units. In reality, this figure was positively affected by the recruitment of medical personnel which took place in 2020 due to the Covid 19 pandemic which saw the entry of around 1,000 doctors, because if we look at the trend up to 2019, the the decrease in medical personnel would be even more pronounced (5,800 units).
In 2021, well 2886 hospital doctors, 39% more than in 2020 he decided to leave the dependency of the NHS and continue his professional activity elsewhere. The greatest escapes were recorded for specialists involved in ED shifts, such as urgents, internists and surgeons.
- Increasingly complex and elderly patients. In 2019, the accesses to the ED broken down by age group show that 28% were patients over 65 years of age. This percentage in 2020 rose to 30.5%. After the age of 65, the average hospital stay rises from the national average of 8 days to almost 9, which for over-85s rises to 11.3 days.
The downward solutions, the economic crumbs do not solve the problem but only try to feed sterile and instrumental wars between the poor.
The problem is not the emergency room but the emergency system of which the crisis in the emergency room is only the obvious and catastrophic effect.
In order to have more personnel, medical work must be rewarding, from a professional and economic point of view, less risky, with reduced workloads and the entire patient management system be optimised. And to deal with boarding, beds are needed, for acute and post-acute cases, territorial assistance and numerically sufficient and satisfied staff. Nothing else.
Clare Rivetti
Secretary Anaao Assomed-Piedmont Region
Pierino Di Silverio
National Secretary Anaao Assomed
05 December 2022
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