Liguria. By the summer in Liguria they will be born clinics dedicated to low complexity in districts or community homes, open from 8am to midnight even on holidaysto avoid patients being forced to always turn to the emergency room. This is what theregional integrative agreement signed by the Liguria Region with the associations of general practitioners (Fimmg and Smi) which will become operational after approval by the regional council.
It is essentially one intermediate stage towards the community house system outlined by the Pnrr. In a first phase there will be clinics one for each socio-health district, with a fixed location which will be communicated to users, and will be manned by general practitioners on a voluntary basis. A patient with non-urgent problems that cannot be resolved in the office will be referred by his doctor or the emergency medical switchboard to one of these hub. The measure will arrive on April 30th furthermore, after which each company will have to verify the feasibility and start recruiting doctors. The goal, in any case, is to start by the summer and then expand the number of clinics in the future.
The agreement also provides for strengthening the relationship between family doctors and specialists with real-time interaction, first-level diagnostics in family doctors’ offices, training and updating of family doctors and above all secretarial and nursing staff dedicated to the activity of family doctors. For these activities the Liguria Region offers 6.1 million additional resources between now and 2027.
“The key element of this entire process is the most efficient and effective care of the patient – explains the Health Councilor Angel Gratarola -. With this agreement, first of all, the family doctor can, if necessary, avail himself of the collaboration of a specialist operating in the local health authority of reference, through the teleconsultation formulas and the tools that are made available by the Region with specific platforms: the doctor places the question to the specialist who, with his intervention, completes the answers to be given to the patient, overcoming any diagnostic doubts. This path is of fundamental importance because it manages to shorten the supply chain and, consequently, improve prescriptive appropriateness. Not only that, this mechanism translates into a reduction in waiting times, thanks to the path that allows you to give answers directly from the specialist, without going through a further visit to the hospital”.
“The strengthening of the office staff, with the figures of secretaries and nurses, together with the possibility of carrying out first-level diagnostics in the office, such as ECG and spirometry, and the activation of teleconsultation with the specialist will allow the doctors’ capabilities to be strengthened of family to respond to the clinical needs of their patients – predicts the Genoese secretary of Fimmg Andrea Carraro -. In this way it will be possible to reduce the inappropriate use of the emergency room and provide quicker responses to the needs of citizens directly in the area”. Even the SMI, “while underlining that the agreement just signed represents only a first step for the reorganization of healthcare in the Ligurian territory, expresses its satisfaction at having seen some of the most important points forming part of its program accepted”, adds the secretary Daniele Gasparotti.
In the meantime in the emergency room the experimentation continues routes dedicated to low intensity. To the Saint martin, where the model has been active since 5 February, from Monday to Friday between 8.00 and 15.00, 840 patients with green or white codes were involved with a decrease in the average waiting time of 2-3 hours. Results similar to Villa Scassi, where the route has been operational since March 18th.
“We are faced with a clear increase in demand: visits to emergency rooms in Liguria increased by 5% compared to 2023 – explains Filippo Ansaldi, general manager of Alisa -. Despite that, episodes of overcrowding have reduced. The strategy of diversified paths for patients who arrive in serious conditions and those who arrive in the emergency room with white and green codes allows us to reduce waiting times. Since the beginning of 2024, our hospitals and the Ligurian local health authorities have implemented diversified actions and paths that have made it possible to reduce the average wait of patients in the emergency room by 2-3 hours. We will continue on this path to respond in an increasingly punctual manner to the increase in demand, alongside the activities linked to continuity of care in the area”.
“An important action, which will allow us not only to optimize waiting times, ensuring these patients can benefit from assistance in a shorter time, but also to promote, in the future, the control of overcrowding – he adds Marco Damonte Prioli, general director of the San Martino polyclinic hospital -. Control which, however, I would like to remember, also takes place through all the fast-track paths already active in our Emergency Department, which allow us to direct low-complexity patients with ophthalmological, orthopaedic, dermatological, gynecological problems, through triage, directly to the relevant clinic. Particular thanks go, in addition to all the healthcare personnel involved in the emergency-urgency, also to our room assistants, currently 3 employees of the Polyclinic who are responsible for supporting professionals in the transfer of information between hospitalized patients and relatives and to the 4 AVO volunteers, for the assistance provided during meal times”.
“Already in November 2019 – he explains Martha Caltabellotta, health director of ASL 3– at the Villa Scassi hospital we had activated a pilot project for the separation of the routes of the white and green codes from those of greater severity, with encouraging results. At the time, this practice was interrupted in January 2020 due to the outbreak of the pandemic. Since March this year, the clinic for minor codes has been restored, with direct and separate access near the emergency room. This activity complements the fast-track protocols already present and dedicated to mono-specialist activities such as, for example, ophthalmology and urology, in addition to the orthopedic clinic. The first results are significant: on the 204 cases treated from mid-March to mid-April, for 95% of cases the initial coding of the triage nurse was confirmed as correct, detecting on average a decrease in the time between access and discharge of around two hours. The clinic is currently open 6 hours a day from Monday to Friday. The objective, given the results, is to increase it”.
