In Italy the emergency room decreases, while the number of doctors only formally grows. Behind the official data has been hiding a structural and organizational crisis ignored for years. Urgent interventions are needed to save emergency medicine
The spark, on a topic that in Italy in recent years ignites the spirits like few others, has been the diffusion – on the occasion of Graduation Day Promoted by Altems (High School of Economics and Management of the Health Systems of the Catholic University)- data on the number of access, doctors and emergency room principals present on the national territory. The numbers seem to suggest an improvement: between 2011 and 2023 the number of doctors dedicated to the emergency-urgency service has grown on average from 3.8 to 6.9 for each emergency room. However, in the same period, the total number of emergency structures dropped from 808 to 693. A first, simple reading could suggest a more efficient system: less emergency departmentsbut more doctors for each, therefore more optimization with an overall drop in accesses (from 363 every thousand inhabitants in 2011 to 311 in 2023) and a reduction of subsequent hospitalizations (from 14.9% to 13%). But reality, according to those who work daily in the emergency departments, are much more complex – and worrying.
On a very close tour, after the dissemination of the data, the authoritative voice of SIMEU (Italian Company Emergency Medicine Urgency), that is, the scientific society that brings together the specialists who work in the emergency room throughout Italy, who has released a very exhaustive note with a examination of the problem. Second President Alessandro Riccardi, Past President Fabio De Iaco And the whole team of emergentists, the Altems data hide several critical issues. Let’s examine them: first of all the apparent increase of specialized medical staff does not necessarily reflect a real strengthening. In many cases, it is simply one administrative reclassification of doctors already in service: in the past framed in disciplines such as internal medicine or surgery, now formally assigned to emergency-urgency medicine. In fact, the voice changes on the contract, but not the real availability of resources on the field. Not only. The data detection system is fragmented and uneven: to date, a unique model does not exist to determine the real need for staff in Italian emergency room. Each region – and sometimes every health company – adopts different management logics. To complicate everything, The absence of data on activities such as OBI (short intensive observation)emergency medicine and management of semi-intensive beds, which still engage the emergency room doctors. In other words: the patients present in the emergency departments should not only be counted, but “weighed”
Growth specialization? Yes, but not enough
Another critical point raised by Simeu’s experts concerns the interpretation of data on specialist doctors. The School of Specialization in Emergency Medicine was born only in 2009 and churned out the first doctors in 2014. The numbers previous to that date concern doctors without the specific training scheduled for today. And also in the following years, the number of banned specialization bags has been limited, making the data that binds “Meu” with real specialist training. Between 2018 and 2023, the category lost about 9% of professionals: a clear and alarming drop, which coincides with the most pessimistic projections formulated by Simeu. An emorrhage of human resources that puts the entire system at risk.
Access numbers don’t tell everything. “We need courage of truth”.
Always from Simeu’s reply, it is clear very well as the mere fact of reducing the analysis of the emergency room crisis to the simple counting of access is misleading. The intensity and complexity of the required care have increased in a significant way. It is not enough to know how many People enter the emergency room: you have to understand what assistance do they require, as for a long time remain in the ward e What resources they are necessary to manage them. Phenomena such as the “Boarding” – that is, the patients forced to stay in the emergency room waiting for a bed – and the “denied hospitalizations” – that is, prolonged stays that, in fact, are equivalent to hospital leaders – are not correctly counted in official data. Still, they represent up to 40% of the real activity of some departments.
“When we just count the number of access to the emergency room, we tell a flat, two -dimensional reality, which does not take into account the deep complexity of what we really do every day” he explains Fabio De Iaco, first aid primary of the Maria Vittoria hospital in Turin and Past-President Simeu. «Access can last six hours, as in the case of a kidney colic that we treat and resign, or it can mean three days of intensive management, with advanced therapies, continuous monitoring, perhaps even with vase-pressure support. Yet those two accesses are counted in the same way. It is clear that there is a problem in the representation of our work. The emergency room today is no longer just a place of sorting of the urgencies: it is a department in all respects, where diagnosis is made, care and often replaces an entire hospitalization. We manage pneumothoraci with chest drainage, non -invasive ventilation patients, resuscitation, complex therapies. But all this is not traced. How many patients end up below ventilation every year in Italy in our emergency room? How many cardiopulmonary resuscitation do we do? We do not know, because these data are not recorded or are not recovered. And when they are recorded, they are entrusted to operators who, while treating, should also manually codify each intervention according to national nomenclators or health classifications, a practically impossible company “. Thus, while we can know with extreme precision how many bloodsters are made every year (because everything is computerized), we do not know anything much more complex and demanding clinical activities. This leads to a short circuit in the evaluation of the work And above all, in the calculation of the needs of staff and resources. Because if you do not measure what is really done in the PS, you can never program correctly. “Telling this truth is not an act of pessimism, it is an act of honesty” continues De Iaco “I myself go by repeating everywhere that good health exists, that there are thousands of positive stories in our hospitals. But to tell that everything is fine, when there are evident flaws in the system, nobody is used. Only those who have the courage to tell the truth can really correct it. For this reason, when a narrative comes out like that of certain studies that say that we are more doctors and we see less patients, it is clear to me clearly that it is not so. Because the numbers must be read, interpreted, and not used to cover a reality that instead deserves attention, respect and – above all – concrete solutions. “
An indispensable discipline, still looking for recognition
In addition, it must also be said that emergency-urgency medicine continues to live a design phase never really concluded: from the birth of the departments in 1992 to the School of Specialization in 2009, until the wait-still in progress-of a national law that defines it with clarity role and competence. Faced with such a complex and confused picture, Simeu’s experts reiterate a clear request: A serious, detailed and unified analysis of the Italian emergency room needs is needed. A work that cannot ignore the involvement of the Ministry of Health, the Regions and above all of the scientific societies, which for years have collected real data and offer tools to read honestly the situation. Only in this way will it be possible to face the crisis, not with statistical illusions, but with concrete interventions, starting from a principle as simple as it is forgotten: The emergency-urgency cannot wait. And let alone the many patients who crowd the first aid departments every day.
