Places of care Interviews

Reorganising spaces during the time of coronavirus

Timeliness, flexibility and multidisciplinary work

Interview with Tiziana Frittelli

Extraordinary Commissioner Tor Vergata Policlinic in Rome

By May 2020July 17th, 2020No Comments
Photo by Lorenzo De Simone

What measures were adopted to cope with the Covid-19 emergency?

The first changes involved the A&E department, which was significantly increased in size, starting with the reorganisation of other departments – normally dedicated to different specialties – the creation of new dedicated triage areas and also separate routes for patients with symptoms of – or suspected – Covid-19. Additionally, for several weeks now the Policlinic has been benefitting from pre-triage tents where patients displaying suspicious symptoms can wait for the results of the swab test. In order to cope with the emergency we immediately started a plan that aimed to increase the number of ordinary inpatient unit beds and the intensive care unit beds, so that both departments could function in parallel (the target of 160 emergency beds was reached within one month). This intervention was possible thanks to the interruption of the deferrable surgeries and the outpatient activities, leaving active only the urgent, oncology and oncology-haematology services (specialisms that the Policlinic is very committed to).

What allowed for a quick response?

It was thanks to a great National Healthcare Service and its timeliness in supporting our actions. We know that coping with an emergency is not possible without having already an organisational basis in place for ordinary work. It is necessary to have what I would define as a military-style organisation and this translates in the ability to vary one’s own networks, even those time-dependent ones – that we know are the most challenging to deal with – to meet different needs. Furthermore, what facilitated these processes was a great collaboration between all the facilities, with a very open-minded direction from the Lazio region, that every single day (weekends included) takes care to ask those involved about the issues encountered. This allowed for the formation of a prodigious team spirit and an unprecedented level of adaptation. I believe that the words of the day are: organisational flexibility of the facilities, which were able to navigate through these new requirements, and teamwork, clearly evident when receptive hospitals welcomed the transfer of patients hospitalised at the Policlinic, which allowed it to deal with the emergency.

The words of the day are: organisational flexibility of the facilities and teamwork.

What might be a possible starting point for the future?

I believe we should start from following an organisational principle that’s been largely adopted during this time, and that has created a drastic decrease in A&E influx. Nowadays people are advised not go to A&E without consulting their GP first. This form of screening should always work. I believe it could reduce by half the influx of non-urgent cases to A&E. It will not be a simple operation. We have to let our doctors develop professionally so a lot of work needs to focus on adapting the training to the hospital training, to use a common language as well. This part is currently working so we should question whether we have the prerequisites and the minimum criteria to continue working well in the future.

Was it easier to intervene in an emergency context?

It was immensely easier because we were exempt from the application criteria for funding, within financial limitations, and the regulations on hiring staff. We were all very wise around expenses – I am certain of this because we are used to being that way – but no limit was placed on the demand for more professionals, and that’s no small thing. We could step up our residents into consultant work, action that would normally require an agreement between the Ministry of Health and the Ministry of Education. No limits were placed on activities of sanitation – that were significantly increased – the out-of-hour work of operators, healthcare teams and all the staff involved. Certainly, the results obtained were only possible thanks to the great skills that all professionals demonstrated in their work at the Policlinic. Starting from the engineering department, that had to rapidly adapt the plant engineering; the protection and prevention service, that after years of providing training on the use of personal protection equipment offered meticulous direction and guidance; the procurement office, committed to speedy searches to purchase equipment and devices; the human resources department, working to hire further staff members. The entire healthcare management made themselves exceptionally available, with such speed that allowed a great management and planning of the network changes, and the transfer of oncology patients (who need continuous care, so the transfer involved the surgical teams as well). To me efficiency is what allows a complex mechanism to function, so that when someone asks you to do something you have already done it. I think that this National, and Regional, Healthcare Service would not have been able to function without the multidisciplinary teams in its arsenal and their great organizational skills, which these stressful phases really put to an extreme test.

Right now, history is asking us which side we are on. Without any doubt, we’re on the side of the most vulnerable, despite the fear.

How did healthcare workers welcome such decisions?

Right now, you can’t get anywhere without putting your heart into it. Therefore, I can say that there has been a great collaboration among healthcare workers, thanks to their expertise and professionalism, and despite the duality between the academic role of the Policlinic and the work of frontline consultants. This highly changeable context impacted surgeons the most. However, they were really understanding of the difficulties that healthcare management deals with when dealing with services, just like management was understanding of the challenges that the surgical teams face when interacting with patients. Together we are looking for a solution that will let the Policlinic reopen its normal activities as soon as possible. I believe that history is now asking us to choose which side we’re on and I reckon that without any doubt- as I wrote to my staff recently in a letter- we’re on the side of the most vulnerable, despite the fear.

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