Over 40% of accesses to the emergency room are represented by white and green codes: patients are therefore almost always discharged shortly afterwards and these are admissions to emergency departments that could be avoided if there was a different response in the area. The reality of emergency rooms in difficulty is photographed by the Minister of Health Orazio Schillaci who, in a hearing at the Social Affairs Committee of the Chamber as part of the fact-finding investigation on urgent Emergency Medicine, also indicates the possible solutions to the problem.
“For 2022, the flow data shows more than 17 million accesses to the emergency room, with 12% in code white (maximum 240 minutes of waiting expected), 50% in code green (120 minutes), 19% in code light blue (60 minutes), 17% in code orange (15 minutes), 2% in code red (0 minutes). The estimate of avoidable accesses (white/green codes with home discharge) shows a percentage of the total greater than 40% “, underlines Schillaci. Compliance with times, on a regional basis, is uniformly guaranteed for the white/green codes, while for blue, orange and red there is considerable variability, and home discharge “represents the predominant share of the outcomes of all accesses, reaching 70% of the total”. One of the critical points, you then stated, is the “involvement and empowerment of extra-hospital care in the management of avoidable accesses”. For this reason, the minister clarifies, “the problem of the emergency room cannot be addressed alone but must be placed within a vision of modern and current healthcare”.
This means “strengthening local medicine, starting from health homes and community hospitals, which – he states – should be designed and built close to hospitals because this makes citizens feel safer if they turn to a structure that maybe it’s close enough to the hospital where you can always access it quickly in case of a more serious code than you might have thought.”
Again with the aim of ‘redesigning’ the face of healthcare, focusing more and more on the territory and professions, Schillaci also announced that among those connected to the 2024 budget he has included two important bills for the “strengthening of local and hospital assistance and for the reform of the health professions, which I intend to define and bring to approval during this year”.
Another crucial issue is the shortage of healthcare personnel, since “there is a lack of around 4,500 doctors and 10,000 nurses at a national level and not all grants in the specialty of Emergency Medicine are assigned due to the profession’s lack of attractiveness”. Hence, the phenomenon of token doctors, which the government is countering. “The number of specialization contracts in emergency and urgent medicine assigned is of concern: there were 510 equal to 47% of the places available in 2021; in 2022 there were 340 and in 2023 there were 245 equal to 29% of the resources allocated at level national”. This trend, he warned, “requires reflection and a discussion has been initiated with the Ministry of the University and the Regions”.
In Italy, in fact, 11 specialization schools have a choice of total places available that does not exceed 50%. The trainees themselves represent a great strength for the NHS: “Today we have 40 thousand doctors in training and we are working to find a better way for the trainees to participate in the activity within the NHS already in the first years of the specialty course”.
Finally, a message that the minister sends to young people: “Those who choose to be a doctor cannot only think of having an economic goal, even though it is right that they have adequate salaries”.
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