Emergency room in trouble with doctors “on the run” and patients waiting for hospitalization. And they could “explode” after Christmas – WWN

Emergency room overcrowded with patients “parked” on stretchers waiting for a bed in the ward or in other facilities; it’s often about patients with more than three pathologies for whom a bed has not been found in the “right” ward, but in many cases there is elderly patients who turn to the emergency room for social-welfare problems that could find a more adequate solution outside the hospital. And then: there are around four thousand doctors missing in the emergency roomsequal to 40 percent of the requirement at national level, e the trend of abandonment continues by the doctors who work there. These are some data that emerged from a survey by the Permanent National Observatory of Simeu, the Italian Society of Emergency Medicine, on a sample of 137 complex MEU (Emergency Medicine) structures, equal to 30 percent of those present in Italy; the data refers to a sample of emergency room accesses equal to more than 6 million, representing 30 percent of the total ED activity.

The investigation

The data analyzed by the Simeu Permanent Observatory, presented in Rome on the occasion of the Academy of Simeu Directors – an operational meeting between the heads of the Italian hospital and university departments of Emergency Medicine – highlight on the one hand the chronic staff shortage in Italian emergency rooms but also the main ones characteristics –
identified by the facility directors interviewed –
of patients cwho more frequently remain on boardthat is, to the emergency room awaiting admission to the ward.

Doctors “on the run”

In the last year more than a thousand emergency doctors (1033) have left the emergency rooms; Of these, seven out of ten have resigned or retired or moved into general practice or private practice, while three out of ten they were transferred to another hospital department. In the last 12 months they have entered emergency rooms 567 new doctorswith an obvious imbalance between leavers and new entries, equal to 45%, so only 55% is replaced. And the trend of doctors “escaping” from emergency rooms continues, also because, as the Simeu investigation reports, the high level of litigation – one criminal case initiated for every twelve doctors – is a further element that does not encourage maintaining, or undertaking, the profession.
A‘insufficient shift coverage necessary by the staff, then generates management difficulties of the emergency rooms, also because, as underlined by the directors of the emergency-urgency structures, the corrections implemented produce a extreme fragmentation of staff within the emergency rooms. For example, the investigation shows that in 54 percent of the EDs there are atypical contracts (each doctor is busy for an average of 4 shifts per month); in one in two emergency rooms managers operate doctors not from the emergency department but from other departments of the hospital, under the additional benefit regime, for a monthly average of 3 shifts; and again: in one emergency room in three are present cooperatives that provide an average of 60 shifts per month (especially in the North: 47 percent, Center: 19 percent, South: 10 percent). Fabio De Iaco, president of Simeu, comments: «If we consider that an emergency room with medium-low activity, no more than 30 thousand visits per year, needs to at least 300 shifts per monthwe realize the small contribution brought about by these solutions, therefore the extreme difficulty of governing the structures”.

Patients with multiple pathologies and social-welfare problems

The survey highlights another phenomenon linked to access to emergency rooms, the so-called «boarding», or the “stop” in the emergency-urgency structureIn many cases on a stretcher, waiting for a bed in the ward. The facility directors have identified the main characteristics of the patients who most frequently stay in boarding; in particular, according to nine out of ten interviewees, it is patients with social-welfare problems, who could find a more adequate solution outside hospitals; two out of three directors report that they are patients with more than 3 pathologies and I’m in the emergency room because a bed was not found in the most suitable ward; finally, six out of ten PS directors say that in many cases it is elderly patients over 80 years old without a support network, for example family or home care.

Inappropriate access to the PS and lack of services in the area

Why does a patient who does not require immediate help for emergency and urgency reasons still go to the emergency room?
For example, explains Dr. De Iaco: «Theeighty year old with multiple pathologies and the fever of 39 he becomes a delirious, dyspneic patient (he has difficulty breathing) with a series of important problems, for which he ends up in the emergency room. And there he risks worsening his condition because he finds himself in an environment with a very high level of pathology which is also contagious but which, in many cases, cannot be contained in the emergency rooms as the spaces are designed today.” The solution? «Give to these patients possible care alternatives in the area, such as care at home or in local facilitiesbut at the same time necessary make emergency rooms more efficient – replies President Simeu -. As? Either through a increase in staffbut also through a profound reinterpretation of architecture and spaces of current emergency rooms. Expanding spaces also means increase the distance between patients; today – denounces President Simeu – they are there many emergency rooms in Italy in which the nurse does not go between one bed/stretcher and another, for example if he has to change the IV, Therefore he has to move the stretchers to provide even urgent care».

Access to the ED by elderly patients with Covid is increasing

And the situation risks exploding with the next peak of seasonal flu. The president of Simeu reports: «These days in various regions Covid patients stuck in emergency rooms are increasing, which obviously must be kept separate from the others. We expect a progressive worsening of the situation in the next month which, probably it will explode right after Christmasboth for the intensification of social contacts and for ecombined effect of flu and Covid on a population that is rarely vaccinated».

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