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[page 128]                                                     [Emergency Care Journal 2018; 14:7913]

                             Emergency Care Journal 2018; volume 14:7913

Dear Editor,

I read the interesting editorial entitled Critical issues of
Emergency Medicine organization in Italy1 by Coen and
Casagranda.

I believe that many relevant problems of our health care sys-
tem (some of them particularly affecting the specific area of emer-
gency medicine: shortage of specialists, the ageing of profession-
als, etc.) should find solutions through the analysis and the revision
of the borders presently dividing professional roles and planning
for future alternative forms of multidisciplinary collaboration.

In many medical disciplines, I think, large room for recovery
from present shortage is possible simply enlarging the tasks of
some professionals and limiting those of others only to the most
specialised ones.

Otherwise is also possible to think at new professional profiles
and new educational pathways proving time for doing that is com-
patible with our actual urgent needs. 

Just to clarify: I’m not thinking at recycling medical working
time downgrading a few medical practices, I think at innovative
collaborative forms of cure. 

The main lesson that comes from the recent history of emer-
gency medicine (its real cultural revolution) stays in its holistic
approach to the patient, alternative to the reductionism typical of
specialist medicine.

Even if this process if far from being completed (as the edito-
rial carefully illustrates), having emergency medicine centred its
medical knowledge around the patient it seems to me that the next
logical step is to revisit professional roles, rules and responsibili-

ties accordingly.
I agree with author’s opinion about the irrelevance of present

attempts of organizational reform. In addition I would mention the
peculiarity of the Italian legislation regulating the work of general
practitioners and family paediatricians.

The distance and separation of these professionals from the
main organisation of the national health system also affects the
area of emergency services (there are general practitioners on the
ambulances of 118, there are General Practice’s running the out of
hours medical assistance of Continuità assistenziale and I’m really
not confident on the potential benefits of the new coming 116177
call centre).

The recently adopted National plan for chronic conditions
clearly describes these limits and the need for overcoming.
Unfortunately, as many of the national plans recently approved, it
does not indicate means and resources to go further.

Finally, I would call attention to a specific, sometimes neglect-
ed, aspect of emergency medicine: the hospital function of front
desk.

The new organisation model of emergency department, its
longer stay (and the consequent internal rearrangement of the hos-
pital), need a clarification about its original scope.

Basically: the organization is only a mean that depends on the
scope…

What is the scope of the emergency department that the edito-
rial describes? Shall it defend the hospital from inappropriate (or
inopportune) admissions or shall it host (receive) the patients and
follow them through their subsequent routes?

I have no doubt! If we can image the hospital not as the high-
specialist terminal of many the medical pathways but simply as a
node of a web of cure (a node to pass through) than the front desk
function of the emergency depth become strategic.

In conclusion: I find difficult to rethink the emergency depth
without rethinking the hospital all together. On the same ground, I
believe that the epidemiological transition urges us to rethink the
total amount of available hospital beds: beds that should be able to
effectively take care of chronical unbalanced patients and not only
ready to put them back into the maze of outpatients services.

References
1. Coen D, Casagranda I. Critical issues of Emergency Medicine

organization in Italy. Emerg Care J 2018;14:90-2.

Correspondence: Vittorio Demicheli, Department of Primary Care, ATS
Pavia, Viale Indipendenza 3, 27100 Pavia, Italy.
E-mail: vittorio_demicheli@ats-pavia.it

Key words: Emergency Medicine organization; Health Care System;
Italy.

Received for publication: 4 November 2018.
Accepted for publication: 5 November 2018.

This work is licensed under a Creative Commons Attribution 4.0
License (by-nc 4.0).

©Copyright V. Demicheli, 2018
Licensee PAGEPress, Italy
Emergency Care Journal 2018; 14:7913
doi:10.4081/ecj.2018.7913

A comment on Critical issues of Emergency Medicine organization in Italy
Vittorio Demicheli
Department of Primary Care, ATS Pavia, Italy

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