Trauma network in Cagliari, beds halved and few doctors: it's a red alert

The beds were not enough before Covid: even then they were below the parameters imposed by the ministerial decrees. They have shrunk during the pandemic. Once the virus emergency has passed, the situation has even worsened, because there is the pressure of patients from other provinces who are flocking to the capital. And with the imminent reorganization of the departments, scenarios of system collapse loom.

Raising the alarm on the conditions of the trauma network in the metropolitan area of Cagliari is Emanuele Cabras, director, orthopaedist, delegate to Brotzu del Cimo, the doctors' union. The one sent to the Arnas leaders is a detailed document, which is based on numbers that seem to be in free fall.

Before the revolution imposed by the pandemic, in the vast area of Cagliari there were four structures (complex operational units) in the orthopedic-traumatology area. There was the Brotzu Orthopaedics, «mainly dedicated to complex pathologies, polytrauma and pediatric traumatology»: 18 beds. The University Orthopedic Clinic and Orthopedics and Reconstructive Microsurgery, both at Marino, were operational: 66 beds in total. In addition, there were another 24 beds in the complex Traumatology and Orthopedics operational unit of the Santissima Trinità. For a total of 108 seats.

Already with these availability , the system «was operating in difficult conditions linked to the lack of provision of a network and the limited availability of operating sessions which have always been the funnel that has affected the performance of the surgical departments», underlines Cabras. Which also provides another number: Ministerial Decree 70 of 2015, which establishes minimum and maximum ceilings, "provided for 132 Traumatology beds in public facilities for the vast area of Cagliari". So the Cagliaritano circuit was not in order. Then Covid arrived, with the revolution of the departments. After the rubble left by the virus "there are currently 74 public beds in the vast area of Cagliari (+ 7 cots at Brotzu), compared to 108 in 2019 and the 132 foreseen by Ministerial Decree 70", writes the doctors' representative.

In addition to the numbers, there is the context: «The stressful situation of this city "traumatology network", warns Cabras , «is aggravated by the crisis of the operational units of the neighboring provinces (in particular Oristano, Nuoro, Lanusei and Sulcis), as well as the closure of an emergency room (Marine Hospital) in the vast area. The lack of medical and nursing staff in the suburbs has made it impossible for these operational units to provide answers to patients who come from their areas of competence. These patients inevitably flock to the vast area of Cagliari (and to our company in particular)." So onto the Brotzu.

Finished? No. Because there is also the problem of the shortage of specialized personnel: «The pandemic caused by Sars CoV2», is the complaint, «has accelerated the retirement of many specialists in the sector, working in hospital facilities, who were not replaced for reasons related to substantial lack of new specialists and problems in managing competitions. The result is a progressive impoverishment of the workforce."

To all this, which would seem sufficient to take away the sleep of those who have to deal with it and of those who work in the sector, is added the " imminent opening of the complex Hand Surgery Structure, with the associated closure of the Orthopedics 2 department. This reorganization would take place with the reduction of several beds in favor of the opening of a maxillofacial surgery facility". Therefore: there will be fewer and fewer beds available. And they already have occupancy rates of 125%, with an exponential increase in the risk of medical errors.

Cabras addresses DG Agnese Foddis and the health directors (Raimondo Pinna) and administrative directors (Ennio Filigheddu) «to clarify the points listed and

identify possible measures to be adopted in order to provide answers to the staff, who are already so significantly stressed, and to the growing needs of users".