There is an emergency in an emergency, which has historical roots but which current events make more evident. The emergency rooms are on the verge of collapse, the wards are filled, ICU data are rising. Remedial measures are being taken to create new Covid beds by suspending non-urgent interventions, but this cannot make up for the shortage of doctors and nurses in hospitals. In this context, how can the temporary structure in Fiera Milano be reactivated?
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The beds at the Portello
The regional resolution provides for the report of a doctor and three nurses for each intensive care bed activated in the hospital, built in record time last spring. Considering that at present the first 153 beds will be activated (divided into 4 modules of 14 seats, 3 of 16 and 7 of 7), there will be a availability of 153 expert intensive care doctors and 459 nurses. Personnel that will be provided by the 18 Covid hub hospitals in Lombardy: each hub will adopt one or more modules. The first, the one that houses the patients already transferred, in the hands of the Polyclinic, between Monday and Tuesday as needed, the module managed by Niguarda will be added and so on.
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The Region ensures that availability is guaranteed: each hub has given availability to manage the necessary personnel. Such as? Internal reorganization, also thanks to the suspension of non-urgent activities. But the accounts do not add up, denouncing opposition and trade unions. Those at the Fair are intensive care: if I close the other surgeries in the hubs, I do not recover anesthesiologists and resuscitators – comments the councilor dem Carmela Rozza -. The Region, to justify the mistake made at the Fair, reduces the presence of specialist assistance in the hubs, therefore, welfare security. All the more necessary, given the jump of serious patients arriving in hospital: yesterday the Covid deaths were 51, we need to go back in May to have so many. The new positives (4,956, 15% of the 32,749 swabs analyzed), 29 new hospitalizations in intensive care and 141 in other wards are steadily increasing. The opening of these modules will involve the transfer of many employees, weakening the hospitals already tried by the pandemic, note the CGIL, CISL and UIL.
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The shortage of doctors
Upstream, there remains the question of the lack of health personnel in the facilities. With the Covid crisis, all hospital companies have strengthened their staff. Each hospital has its own call with which from March, without interruption, it recruits personnel, but not enough, says the general secretary of Anaao-Assomed Lombardia Stefano Magnone. The reason? You cannot find the specialists you need (anesthetists and resuscitators, pulmonologists, infectious doctors and urgent specialists) and you can easily contract the trainees.
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Let’s try to clarify. In Lombardy, the doctors’ union estimates that 1,800 specialists will be missing by 2025 (a figure that will only grow now, with the national competition being blocked). At the root of the problem is a too low number of specialist grants compared to graduates and, above all, to the needs of hospitals. To make up for this lack – explains Magnone – it was allowed to hire the trainees in recent years already included in the rankings in Lombard hospitals with part-time contracts. In February the Region signed an agreement with the universities, but, despite this, many faculties resist, to keep their postgraduates in university hospitals.
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Nurses in the ward
Same goes for nurses: companies today have no staff to draw on. The shortage of 53 thousand nurses at national level derives from competitions blocked for years, fictitious rankings with the same names entered several times, lack of planning of the number of admissions to universities and the way in which the needs of companies are calculated every three years. The international scientific literature states that the basic numerical ratio for reducing mortality and adverse events should be 1 nurse for every 6 patients. Today in the basic medicine wards we are 1 in 12, in some cases 1 in 15, says Mimma Sternativo, general secretary of Fials Milano Metropolitan Area. For reasons of costs, in fact, reference is still made to a law of the 80s which refers to assistance minutes. Now that the type of patients has changed, this does not guarantee a correct quality of care. In November, the rankings for fixed-term hires will come out, but new hires must be trained: they cannot go immediately where they are needed now, in intensive care and in the emergency room.
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25 October 2020 | 07:30
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