Hospitals and family doctors don’t talk to each other: 6 billion wasted on hospitalizations

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A communication blackout that costs dearly: at least 6 billion in useless hospitalizations. Because hospital specialists and family doctors speak to each other too little given that they consult each other when a patient is hospitalized in just 15% of cases, while in eight out of ten cases patients arrive in the ward without anything being known regarding their medical history. health because the electronic health record is updated just one time in five. So we should not be surprised if on average three hospitalizations out of 10 might have been avoided with better care of patients by local services. Which in absolute numbers it does 2 million 250 thousand avoidable hospitalizations per yearequal to one waste of around 6 billioncalculating that the average cost of hospitalization is around 3 thousand euros.

There are still too many “social” and improper hospitalizations

The not very comforting photograph of the wall that separates hospitals and the territory in healthcare was taken by survey conducted by Fadoi, the Federation of hospital internal medicine doctors, on a representative sample of all the Regions. Two almost incommunicable worlds that end up generating improper access to emergency rooms and avoidable hospitalizations. Problems that for only 7.6% of doctors can be solved by hospitals and community homes, the fulcrum of the territorial health reform financed overall with over 7 billion from the Pnrr. But let’s get to the data: starting from “social” hospitalizations – i.e. patients who might have been cared for even at home if only there was a home care service or a family network capable of looking following them – these represent 20% of the total in ’31, 7% of the structures consulted while the share exceeds 30% in 15.4% of the hospitals and 40% in 4.7% of the same, for an average of one hospitalization in 5. In 34.1% of the structures there would have been able to avoid a good 30% of hospitalizations with better care of patients in the area. Percentage of improper hospitalizations is more than 40% in 33.7% of hospitals, while in other hospitals the share of avoidable hospitalizations varies between 10 and 20%. Only 1.8% do not report improper hospitalizations due to deficiencies in local healthcare.

Little dialogue between hospital workers and family doctors, health records at a standstill

There were various actions which, in the opinion of hospital internal medicine doctors, might have prevented patients from staying in the ward. For 32.6% a greater relationship between hospital and territory would be needed, for another 32.4% a greater offer of integrated home care, for 21% new homes and community hospitals would be sufficient and for 13.9% it would be a more continuous opening of family doctors’ offices is necessary. But above all to communicate – even without speaking – the hospital and the territory would have a tool and it is the Electronic health record, which should contain our entire health history, from the pathologies that afflict us to the treatments we take when we end up in hospital. It’s a shame that local doctors, also due to bureaucratic cumbersomeness, are unable to update it in 39.3% of cases or rarely do so in 41% of cases. Similar percentages are found when it comes to surveying the dialogue between hospital and local doctors. In 71% of cases, the former consult family doctors only rarely when a patient is hospitalized, while for 13.7% the consultation never takes place. However, it occurs quite frequently in just 15% of cases. The consultancy always activates just 0.2% of the time.

A disconnect between hospital and territory that has lasted for many years

«The survey conducted in recent days by Fadoi demonstrates with numbers what we as hospital interns have always denounced, namely the almost total disconnect between the hospital and the territory. Anachronistic in a country which, as it ages, sees an increase in the number of chronic patients with multiple pathologies that require global management, which includes both the phase preceding hospitalization and the following”, warns the President of the Federation, Francesco Dentali. «Unfortunately, as our doctors report by a large majority – continues Dentali -, this fracture will not be mended by the local healthcare reform financed with money from the Pnrr, which designed the walls of the new structures, without defining who works there and how relationship with the hospital.” «As the results of the survey show, we need clear and established rules at a national level that link the entire chain of the National Health Service. Today instead – he states Dario Manfellottopresident of the Fadoi Foundation – the treatment paths are fragmented and bottlenecks often form which clog up the structures”.