Donini: “Fundamental step towards a more effective and sustainable system, to guarantee the best possible assistance for patients and the quality of work of professionals”
June 6, 2023 – A fundamental step forward for the emergency emergency reform wanted by Emilia Romagna regionamong the first in Italy to rethink the system to make it more effective, sustainable and at the same time guarantee the health of citizens and the quality of work of the health professionals who work there.
It was indeed signed the agreement between the region and thetrade union organisation of general practitioners FIMMG according to which the “medical guards”, now Doctors of Continuity of Care, will work as a team Medical Assistance Centers for Emergencies on a territorial basis, which the Region is implementing. They will act as regards the management of the urgent health needs of low complexity citizens, usually identifiable as white and green codes. The latter today represent about 70% of the services that pour into the Emergency Department.
The union organizations in question are headed by both i family doctors (technically referred to as “single role of choice-cycle primary care”) and the former medical guards (“single role of primary care with hourly activity”) but it will above all be the latter to have a decisive function in the new model that is taking shape.
The agreement – illustrated this morning in Press conference in the Region – resumes and makes its own the fundamental principles identified by the current legislation National collective agreement for general medicine of 2022 which, in the light of demographic and technological changes, underlines the need for a overall citizen care it’s a greater integration of general practitioners in the territorial networks of services. This integration, according to the national contract, avoids access to the emergency room for non-urgent services.
“A very important agreement reached with the unions of general practitioners, because their contribution is essential to make a system that is no longer sustainable even more efficient and capable of responding to the new needs of care and assistance – explains the councilor health policies, Raffaele Donini-. This is a fundamental step: it will certainly take time and gradually to implement this reform, but I am confident that we will soon arrive at a more effective and sustainable system, guaranteeing the health of citizens and the quality of the work of professionals”.
The agreement, “Involvement of doctors in the single role of primary care in territorial structures for low complexity emergencies”, starts from two premises: the involvement of doctors in the single role of primary care in the organization and planning of territorial district, corporate and regional level it is a consolidated experience that characterizes Emilia-Romagna as an avant-garde region; the doctors confirmed their willingness to actively participate in the emergency-urgency reorganization process, both guaranteeing support in the planning phase and making themselves available, where possible, for the activation of local structures for low-complexity emergencies.
The key points of the agreement
The agreement identifies two distinct channels: emergencies low complexity are basically the responsibility of the former medical guards and, subordinately and voluntarily, to family doctors, leaving emergencies of complexity to the 118, Emergency Department and DEA (the Departments of Emergency, Urgency and Acceptance at hospitals) medium or high.
The first case includes situations in which the patient can walk independently, experiences mild or moderate pain, presents a clinical picture whose diagnosis can be resolved on site perhaps after an echocardiogram, an ultrasound, x-rays where foreseen or basic biochemical tests. It may also be the case for non-serious situations involving gastrointestinal symptoms, low-onset fever, low back pain, non-traumatic joint pain, minor burns, anxious states, dizziness, but also medications or removal of stitches for tourists or off-site students temporarily without of attending physician.
After the visit, the patient can be referred to their own doctor, or vice versa be sent to the emergency room if you encounter situations of clinical emergency. In fact, the CAU doctors will be connected by telephone with the operations center of 118 and they will have the times and telephone numbers of the attending physicians available. It will be more easily directed to Emergency room For example, if you complain of chest pain, severe abdominal pain, an unusual severe headache, an acute neurological disorder or difficulty breathing.
I lphysical locations where low complexity emergencies will be managed will be i CAU (see Attachment), structures to be built throughout the territory – at least one per district – to ensure coverage for the entire regional population, with particular attention to non-urban or less populated areas: preferably set up in the Community housesbut also in suitable premises made available by Health Trusts or Municipalities, or obtained from emergency department conversion e first aid points or activated at local hospitals without DEA. Even a structured aggregative form of general medicine, organized and suitable, can be the site of such care settings.
The CAUs will be active 7 days a week with the aim of covering 24 hoursin relation to the expected volume of activity and the needs of the territory.
The structures will be equipped with a waiting room, an examination room, a brief post-examination observation room, services, an IT system, adequate technical-sanitary equipment for the main diagnostic tests and will have to see at least one doctor and one nurse at work. Such staff cannot carry out home care activities at the same time. The setting up of the technological equipment will be the responsibility of the Region and will go hand in hand with the training activities necessary for the doctors of the facility.
Doctors on duty, in recognition of the required commitment, will be assigned a incentive additional hours of 18.35 euros which are added to the 23.65 euros provided for by the national contract.
Ample space of the agreement is in fact reserved for the educational goals for the doctors involved, who obviously cover a very varied picture ranging from paediatrics to dermatology, from cardiovascular to respiratory issues, from neurology to ophthalmology without neglecting cases of lacerations or problems with the musculoskeletal system. All, of course, within the overall picture of low complexity: for the most serious cases, the emergency room specialist will continue to be necessary.