The health emergency situation that has been gripping Italy and the whole world for many months has led all the countries of the globe to revise the structure of their health system. In particular, in this pandemic context, attention was constantly paid to an extremely important department of the hospital: the Intensive Care Unit. Since the new Coronavirus SARS-CoV-2 has spread in Italy, the size and the possibility of hospitalization of these departments have raised great alarm, thus leading the health authorities to take actions and measures to expand, in the shortest possible time, the number of beds available. Funds were therefore allocated to allow the extension of the wards and the creation of new hospitals capable of accommodating patients suffering from this still little known disease. Covid-19 occurs in patients in different ways: in the simplest cases, it shows mild symptoms such as fever, cold and cough, while, in the more advanced stages, the patient is struck by a serious respiratory tract infection, which makes it essential hospitalization in ICU for treatment with invasive machinery such as, for example, the mechanical ventilation device, necessary to assist the patient during breathing. The goal of this work is, on the one hand, to analyze the sizing and readjustment of the Italian health system, compared to the other main European countries, to offer a new possible model of hospital management, which is configured in the creation of structures more easily adaptable to sudden needs of health, changeable and elastic in size and composition. The first chapter illustrates the general organization of an intensive care unit, paying attention to both its structure, its correct placement within the hospital and the technological-structural requirements, and the treatment and care of individual patients. This section also highlights the importance of the semi-intensive care unit, which is appropriate to ensure proper functioning of the health complex and to ensure a high turnover of beds. In order to understand the choices made by some of the most emerging European countries, relating to the methods of fighting the epidemic, the health systems of Italy, Spain, the United Kingdom, France and Germany are treated. In this regard, for each single nation, the indices and health expenditure, necessary for the evaluation and sizing of each system, are described. In the second chapter, the Italian hospital reorganization method, which took place following the spread of the virus, is explained. Italy was the first country, after China, to live and have to face this health emergency, but despite the many problems that have arisen, the efforts made by the highest competent authorities have certainly been significant, so much so that it deserves positive comments. At the beginning of the pandemic, the number of ICU beds was close to 5100 units, with a utilization rate just under 50%; this value appears to be adequate and indicates a correct dimensioning of the Italian health system thus allowing to provide the right level of hospital care. With the advent of Covid-19, the effort has focused on expanding the number of units within these departments; right from the start, there was the awareness that the high rate of spread of the virus would make the resuscitation wards close to saturation. The Ministry of Health, by issuing provisions and decrees, on the one hand, immediately arranged for the enlargement of 50% of the beds in IT and, on the other hand, carried out the creation of extraordinary calls for the recruitment of new doctors and nurses . To make an intensive care unit efficient and operational, the adequate presence of a number of anesthetist-intensive care practitioners and specialized nurses for each patient unit is a must. With the expansion of these departments, the system found itself understaffed, having to resort to retired doctors or doctors from other states. To counter this problem, a different method of managing patients would be advisable, entrusting general practitioners with the correct sanitary support, so as to allow them to treat Covid-19 subjects in the initial stages of the disease, guaranteeing immediate care and reducing , thus, the load on the emergency room and the resuscitation wards. In the final chapters, the third and fourth, attention is paid to the problem concerning the high risk of contagion, which has led to the postponement of multiple surgeries for oncological patients or those with severe heart diseases, thus causing a worsening of their quality of life. As a consequence, therefore, entire complexes have been predisposed to the treatment of Covid-19 patients. With the advent of a second pandemic wave, a further delay in the treatment of these subjects could further compromise their state of health. In this regard, the possibility of creating structures able to accommodate both types of patients, guaranteeing them an appropriate level of safety, is being discussed. On the one hand, therefore, the establishment of an adequate surveillance system is suggested, in order to constantly monitor the flow of personnel within the area and, on the other, the creation of specific corridors is required, differentiating the “clean” paths from the “dirty” ones, as well as filter areas at the entrance of the structures and of each single department, so as to once again ensure a sanitization and disinfection process. In the work, is also highlight the importance and use of lifts: a sufficient number of these systems should be set up, adequately sanitized at the end of each use, to allow healthy and infected patients to move vertically within the structure. In conclusion, with this paper, we want to propose a new model of hospital management, which turns into the creation of elastic systems, that is to say structures predisposed, from the moment of their establishment, of empty and functioning spaces, which have all the necessary instrumentation to be able to be of support in conditions of extreme necessity, thus making health care intervention more immediate and timely. In the current context, these wards could quickly be converted into Intensive Care Unit, but the basic idea is to transform them into any type of hospital stay, in the face of possible future health emergencies.
La situazione di emergenza sanitaria che da molti mesi sta attanagliando l’Italia e il mondo intero, ha portato tutti i paesi del globo a rivedere l’assetto del loro sistema sanitario. In particolar modo, in questo contesto pandemico le attenzioni sono state costantemente rivolte a un reparto dell’ospedale di estrema importanza: la Terapia Intensiva. Da quando il nuovo Coronavirus SARS-CoV-2 si è diffuso in Italia, il dimensionamento e le possibilità di ricovero di questi reparti hanno destato grande allarme, portando così le autorità sanitarie a intraprendere azioni e provvedimenti per ampliare, nel minor tempo possibile, il numero di posti letto disponibili. Sono quindi stati stanziati fondi per poter permettere l’estensione dei reparti e la creazione ex-novo di strutture ospedaliere in grado accogliere i degenti affetti da questa malattia ancora poco conosciuta. Il Covid-19 si presenta nei pazienti in modalità differenti: nei casi più semplici, evidenzia sintomi lievi quali febbre, raffreddore e tosse, mentre, negli stadi più avanzati, il soggetto è colpito da una grave infezione alle vie respiratorie, che rende indispensabile il ricovero in TI per il trattamento con macchinari invasivi come, ad esempio, il dispositivo per la ventilazione meccanica, necessario per assistere il degente durante la respirazione. Con questo elaborato si intende, da un lato, analizzare il dimensionamento e il riadattamento del sistema sanitario italiano, rapportato agli altri principali Paesi europei e, dall’altro, offrire un nuovo possibile modello di gestione ospedaliera, che si configura nella creazione di strutture più facilmente adattabili a improvvise necessità di salute, mutevoli e elastiche nelle dimensioni e nella composizione. Nel primo capitolo viene illustrata l’organizzazione generale di un reparto di Rianimazione, ponendo attenzione sia alla sua struttura, al suo corretto collocamento all’interno dell’ospedale e ai requisiti tecnologici-strutturali, che al trattamento e alla cura dei singoli pazienti. In questa sezione, inoltre, viene evidenziata l’importanza del reparto di terapia semi-intensiva, opportuno per garantire un corretto funzionamento del complesso sanitario e per assicurare un elevato turnover dei posti letto. Per poter comprendere le scelte effettuate da alcuni dei paesi europei più emergenti, relative alla modalità di contrasto dell’epidemia, vengono trattati i sistemi sanitari di Italia, Spagna, Regno Unito, Francia e Germania. A tal proposito, per ogni singola nazione, vengono descritti gli indici e la spesa sanitaria, necessari per la valutazione e il dimensionamento di ogni sistema. Nel secondo capitolo, si espone la modalità di riorganizzazione ospedaliera italiana, avvenuta in seguito alla diffusione del virus. L’Italia è stata il primo paese, dopo la Cina, a vivere e dover affrontare questa emergenza sanitaria, ma nonostante le molteplici problematiche presentatesi, gli sforzi compiuti dalle massime autorità competenti sono stati sicuramente rilevanti, tanto da meritare commenti positivi. A inizio pandemia il numero di letti in Terapia Intensiva era prossimo alle 5100 unità, con un tasso di utilizzo poco inferiore al 50%; questo valore risulta essere adeguato e indica un corretto dimensionamento del sistema sanitario italiano permettendo, così, di fornire il giusto livello di assistenza ospedaliera. Con l’avvento del Covid-19 lo sforzo si è concentrato sull’ampliamento del numero di unità interne a questi reparti; fin da subito, vi era la consapevolezza che l'elevato tasso di diffusione del virus, avrebbe reso i reparti di Rianimazione prossimi alla saturazione. Il Ministero della Salute, emanando provvedimenti e decreti, da un lato, ha immediatamente predisposto l’allargamento del 50% dei posti letto in TI e, dall’altro, ha espletato la creazione di bandi straordinari per l’assunzione di nuovi medici e infermieri. Per rendere efficiente e operante un reparto di Rianimazione è doverosa l’adeguata presenza di un numero di medici anestesisti-rianimatori e infermieri specializzati per ogni unità paziente. Con l’ampliamento di questi reparti, il sistema si è trovato sotto organico dovendo ricorrere a medici pensionati o provenienti da altri Stati. Per contrastare questa problematica, sarebbe consigliabile un differente metodo di gestione dei malati, affidando ai medici di base il supporto igienico-sanitario corretto, così da permettere loro il trattamento dei soggetti Covid-19 negli stadi iniziali della malattia, garantendo delle cure immediate e riducendo, così, il carico sui Pronto Soccorso e sui reparti di Rianimazione. Nei capitoli finali, il terzo e il quarto, si pone attenzione alla problematica concernente l’elevato rischio di contagio, che ha determinato il rinvio di molteplici interventi chirurgici per malati oncologici o con severe patologie cardiache, causando, così, il peggioramento della loro qualità di vita. Come conseguenza, dunque, interi complessi sono stati predisposti al trattamento di pazienti Covid-19. Con l’avvento di una seconda ondata pandemica, un ulteriore ritardo nel trattamento di questi soggetti, potrebbe compromettere maggiormente il loro stato di salute. A tal proposito, si discute la possibilità di creare strutture in grado di ospitare entrambi i tipi di pazienti, garantendo loro un livello di sicurezza appropriato. Da un lato, quindi, viene suggerita l’istituzione di un sistema di sorveglianza adeguato, al fine di monitorare costantemente il flusso del personale all’interno dell’area e, dall’altro, viene richiesta la creazione sia di corridoi specifici, differenziando i percorsi “puliti” da quelli “sporchi”, che di zone filtro all’ingresso delle strutture e di ogni singolo reparto, così da assicurare nuovamente un processo di sanificazione e disinfezione. Si vuole mettere in luce l’importanza e l’impiego degli ascensori: è opportuno che venga predisposto un numero sufficiente di questi sistemi, adeguatamente igienizzati al termine di ogni utilizzo, per permettere ai pazienti sani e infetti spostamenti verticali all’interno della struttura. In conclusione, con questo elaborato, si vuole proporre un nuovo modello di gestione ospedaliera, che si tramuta nella creazione di sistemi elastici, vale a dire strutture predisposte, fin dal momento della loro istituzione, di spazi vuoti e funzionanti, che dispongano di tutta la strumentazione necessaria per poter essere di supporto in condizioni di estrema necessità, rendendo così più immediato e tempestivo l’intervento di assistenza sanitaria. Nel contesto attuale, tali reparti si potrebbero rapidamente convertire in Terapie Intensive, ma l’idea basilare consiste nella loro trasformazione in qualsiasi tipo di degenza ospedaliera, a fronte di possibili emergenze sanitarie future.
Analisi dell'organizzazione delle terapie intensive italiane durante la pandemia di Covid-19
Figini, Daniele
2020/2021
Abstract
The health emergency situation that has been gripping Italy and the whole world for many months has led all the countries of the globe to revise the structure of their health system. In particular, in this pandemic context, attention was constantly paid to an extremely important department of the hospital: the Intensive Care Unit. Since the new Coronavirus SARS-CoV-2 has spread in Italy, the size and the possibility of hospitalization of these departments have raised great alarm, thus leading the health authorities to take actions and measures to expand, in the shortest possible time, the number of beds available. Funds were therefore allocated to allow the extension of the wards and the creation of new hospitals capable of accommodating patients suffering from this still little known disease. Covid-19 occurs in patients in different ways: in the simplest cases, it shows mild symptoms such as fever, cold and cough, while, in the more advanced stages, the patient is struck by a serious respiratory tract infection, which makes it essential hospitalization in ICU for treatment with invasive machinery such as, for example, the mechanical ventilation device, necessary to assist the patient during breathing. The goal of this work is, on the one hand, to analyze the sizing and readjustment of the Italian health system, compared to the other main European countries, to offer a new possible model of hospital management, which is configured in the creation of structures more easily adaptable to sudden needs of health, changeable and elastic in size and composition. The first chapter illustrates the general organization of an intensive care unit, paying attention to both its structure, its correct placement within the hospital and the technological-structural requirements, and the treatment and care of individual patients. This section also highlights the importance of the semi-intensive care unit, which is appropriate to ensure proper functioning of the health complex and to ensure a high turnover of beds. In order to understand the choices made by some of the most emerging European countries, relating to the methods of fighting the epidemic, the health systems of Italy, Spain, the United Kingdom, France and Germany are treated. In this regard, for each single nation, the indices and health expenditure, necessary for the evaluation and sizing of each system, are described. In the second chapter, the Italian hospital reorganization method, which took place following the spread of the virus, is explained. Italy was the first country, after China, to live and have to face this health emergency, but despite the many problems that have arisen, the efforts made by the highest competent authorities have certainly been significant, so much so that it deserves positive comments. At the beginning of the pandemic, the number of ICU beds was close to 5100 units, with a utilization rate just under 50%; this value appears to be adequate and indicates a correct dimensioning of the Italian health system thus allowing to provide the right level of hospital care. With the advent of Covid-19, the effort has focused on expanding the number of units within these departments; right from the start, there was the awareness that the high rate of spread of the virus would make the resuscitation wards close to saturation. The Ministry of Health, by issuing provisions and decrees, on the one hand, immediately arranged for the enlargement of 50% of the beds in IT and, on the other hand, carried out the creation of extraordinary calls for the recruitment of new doctors and nurses . To make an intensive care unit efficient and operational, the adequate presence of a number of anesthetist-intensive care practitioners and specialized nurses for each patient unit is a must. With the expansion of these departments, the system found itself understaffed, having to resort to retired doctors or doctors from other states. To counter this problem, a different method of managing patients would be advisable, entrusting general practitioners with the correct sanitary support, so as to allow them to treat Covid-19 subjects in the initial stages of the disease, guaranteeing immediate care and reducing , thus, the load on the emergency room and the resuscitation wards. In the final chapters, the third and fourth, attention is paid to the problem concerning the high risk of contagion, which has led to the postponement of multiple surgeries for oncological patients or those with severe heart diseases, thus causing a worsening of their quality of life. As a consequence, therefore, entire complexes have been predisposed to the treatment of Covid-19 patients. With the advent of a second pandemic wave, a further delay in the treatment of these subjects could further compromise their state of health. In this regard, the possibility of creating structures able to accommodate both types of patients, guaranteeing them an appropriate level of safety, is being discussed. On the one hand, therefore, the establishment of an adequate surveillance system is suggested, in order to constantly monitor the flow of personnel within the area and, on the other, the creation of specific corridors is required, differentiating the “clean” paths from the “dirty” ones, as well as filter areas at the entrance of the structures and of each single department, so as to once again ensure a sanitization and disinfection process. In the work, is also highlight the importance and use of lifts: a sufficient number of these systems should be set up, adequately sanitized at the end of each use, to allow healthy and infected patients to move vertically within the structure. In conclusion, with this paper, we want to propose a new model of hospital management, which turns into the creation of elastic systems, that is to say structures predisposed, from the moment of their establishment, of empty and functioning spaces, which have all the necessary instrumentation to be able to be of support in conditions of extreme necessity, thus making health care intervention more immediate and timely. In the current context, these wards could quickly be converted into Intensive Care Unit, but the basic idea is to transform them into any type of hospital stay, in the face of possible future health emergencies.File | Dimensione | Formato | |
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https://hdl.handle.net/10589/171254