In Italy, structures that carry out a few thousand access to the year remain open, where the risk for the patient is ten times higher than the larger nosocomes.
The dimensions count. Especially in healthcare. And even if it would certainly be more comfortable to ignore this truth and culla us in the idea that having a hospital, a emergency room, a birth point a few meters from home guarantees speed and appropriateness of care, reality tells us something very different.
In a country that is facing a chronic lack of beds and a very serious lack of doctors, small hospitals, often, are only a false security.
Worse: a trap that risks making us waste precious time when salvation is a matter of minutesor to make us run into doctors and departments that, despite the commitment, may prove inadequate. It is not a question of alarmism, but of facts. “Getting to a small emergency room, with a few thousand access to the year, means for the patient to take a risk ten times higher than a large and structured garrison” says Andrea Bellone, former primary of the emergency and urgency department of the Niguarda hospital in Milan and president of the critical area. “Especially in the case of time-dependent pathologies, such as heart attack or stroke, where as much speed as possible to save the life and autonomy of patients, the transition from a small hospital-perhaps even for an initial underestimation of symptoms is needed-it means playing a series of possibilities of care and lowering survival chances”. Yet, in 2015, Ministerial Decree 70 (the Balduzzi ministerial decree) had planted rather stringent stakes, providing for the closure of those unsuitable hospitals – due to the lack of structural requirements or for a clinical activity with low volumes – to a health management at the level of the complexity of the current challenges.
Based on that decree, all emergency room should be closed (and the related hospital principals) With less than ten thousand access annual access: pity that in reality this has practically never happened, even for the protests of politics and citizens, given that on hospitals and health there is a good slice of political consent and patronage.
“The latest data in our possession, referring to 2022, tell us that today in Italy 102 First aid are active in Italy that do too much access: about nine thousand a year, less than a patient per hour” explains the endocrinologist Guido Quici, president of Cimo (Italian coordination of hospital doctors). «But the emergency, to work, needs adequate staff, cutting -edge machinery, new drugs and the collaboration of the hospital wards and specialists. All this, in small hospitals, cannot be done ».
Obviously the regional differences are enormous: For example, if in Friuli-Venezia Giulia there is no emergency room with less than ten thousand accesses annual and in Liguria and Marche there are only three, in Sicily there are 14 (almost 15 percent of the Italian total), and many of them, excluding those of the minor islands and disadvantaged areas, being very close to large structured hospitals would have no reason to exist, if not for merely customers.
Just in Sicily, finding the data is a difficult company: Just think that a large report drawn up by a technical commission made up of primary PS – on the direct initiative of the Sicilian Region – and in charge of verifying the functioning of all 66 principals of the island, was mysteriously “secreted”, after the results had been disclosed to the Health Department. While in Campania, in early April, a very heated event in defense of the emergency room of Sant’Agata de ‘Goti saw the governor Vincenzo De Luca close (rightly) to any possibility of strengthening a PS that in fact is useless, responding to those who protested with a complexion: “You are a continuous complaint!”.
Other problems weigh on small hospitals: Young doctors do not want to go into garrisons with little cases and poor career possibilities, and also the professionals who work there for years have tended to escape towards larger structures. “Today, a doctor from a marginal hospital” continues Quici “knows that he will have to do several nights a month, he will have to work on the holidays and cover many shifts of his few colleagues. Just someone who goes to illness to blow up all the balance. Of course these hospitals empty themselves ».
Furthermore, to keep small principals open at all costs, the health companies often impose their specialists who work in the larger hospitals to move to the minor ones, even if only for a day a week, to ensure the functioning of a department or an operating room, lowering the quality of the overall care in the area.
“If, for example, an anesthesiologist of an important hospital must, every Tuesday, go to exercise in a suburban garrison with a ridiculous number of patients, does not solve the problems of the small hospital, deplete the largest novomy and contributes to the problem of the infinite waiting lists” concludes Quici.
And also in what is perhaps the most delicate and “emotional” area within our healthcarethat is, the path of pregnancy and childbirth, the situation is not rosy. According to the data of the Fiaso (Italian Federation of Health and Hospital Companies), out of 400 birth points in Italy, a quarter – that is 100 – does not respect the goal of the number of minimum parties (a thousand in a year) provided for by law. “These birth points continue to operate in derogation, often for geographical reasons,” says Giovanni Migliore, president of the Italian Federation of Health and Hospital Companies. «It is good that the population, however, is aware of the fact that the numbers are very important. The lower volumes are low, the higher the percentage of adverse events that can occur during childbirth. Obviously that future mothers would prefer to give birth in their cities, close to affections and with all comforts. But it is always necessary to put security in the first place ». For themselves and for those who come to the world.
Because with life and health it is good not to joke: We always look for, in any eventuality, not the nearest hospital, not the most comfortable one. But only and always the most suitable, the safest.
