Overbooked medical departments in hospitals: many admissions due to social causes

The Internal Medicine departments of Italian hospitals, where about half of all hospitalized patients flow, especially elderly and complex chronic patients, are so saturated that they are overbooked: in 58% of them, in fact, the bed occupancy rate is over 100% and this means that patients are even forced to lie on a stretcher in the corridor, with only one partition to guarantee privacy. The emergency is also exacerbated by the chronic lack of staff, found in 85.65% of departments from North to South. Many of the hospitalizations are also attributable to 'social' causes, that is, the lack of assistance outside the hospital which inevitably delays discharge. Yet, as many as 1 in 3 hospitalizations would generally be avoidable with better management by local health services and if more prevention was done.

A worrying picture emerges from the new survey conducted by the Federation of Italian Hospital Internal Medicine Doctors (Fadoi) on 216 operating units in all regions, presented at the 30th congress of the Federation. "The increasingly critical situation in which our departments find themselves operating - explains the president of Fadoi Francesco Dentali - depends not least on the incorrect classification of the Internal Medicine departments as low, rather than medium-high intensity of care. This in fact translates into a lower provision of personnel and diagnostic equipment". Furthermore, "there are many patients, especially elderly ones, who remain for 'social' reasons, because they could not have adequate assistance if they were discharged, and this phenomenon of 'hospitalizations for social reasons' further aggravates the chronic shortage of beds". Even if there are some positive signs, and the percentage of those who go home but with integrated home care activated has risen to 43.98%. In general, Dentali notes, "the number of beds is seriously insufficient: Italy has less than half of Germany, and with an aging population. Their number in Internal Medicine is 35 thousand and, overall, Italy has 3.1 beds per thousand inhabitants against 8 in Germany and placing itself below the EU average".

A situation carefully considered by the Minister of Health Orazio Schillaci who, speaking at the congress, underlines how "we cannot continue to think of Internal Medicine as a reservoir to make up for the shortcomings of social assistance systems. We must therefore invest - he states - in new organizational models and this is what we are doing with the Pnrr to strengthen assistance in the territory and home care". The minister then recognizes that Internal Medicine "does not find full recognition in regional organizational models, which often see internal medicine placed among the low-intensity care departments. I will try to correct this - he announces - with a Ministerial Decree that will also redefine hospital standards". If for Schillaci the reform of territorial assistance is the solution, Fadoi nevertheless underlines how it "struggles to take off" and, in a mix of hope and skepticism, 72.22% of internists believe that the new Community Houses will actually be able to reduce the number of hospitalizations, "but we will have to see how they will be implemented".

On the other hand, it is also true that one in 3 hospitalizations and over 2 million days of hospitalization could be avoided by focusing on local services and greater prevention, says Fadoi, and Schillaci notes that the Regions should spend at least 8% of the Health Fund on prevention against the current 5%. In 35.19% of departments, in fact, 11-20% of hospitalizations are due precisely to little prevention, from incorrect lifestyles to poor adherence to screening and vaccinations. Finally, between overcrowding in departments and staff shortages, it is not surprising that 48% of internists say they no longer find time to do research. A significant damage, "because where research is done, the quality of care also improves", concludes President Fadoi.