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Over 2,100 inappropriately hospitalised

Adhy Savala on Unsplash

As of 20 March, 2,164 people were inappropriately hospitalized, corresponding to more than 378,000 days. Waiting for a place in long-term care is the main reason for the problem, according to data from the 8th edition of the Social Inpatient Barometer presented on Wednesday at the Northern Rehabilitation Centre.

Lisbon and the Tagus Valley and the North are the regions that most feel the impact of the lack of responses to patients who have already been discharged - "they account for 83 % of all inappropriate hospitalisations and 98% of the total number of days".

The barometer, carried out by the Portuguese Association of Hospital Administrators (APAH), with the support of the Association of Social Service Professionals (APSS) and the Portuguese Society of Internal Medicine (SPMI), only takes a snapshot of one day. This year, 39 NHS organisations took part, representing 90% of hospital beds (20,288).

This year's inappropriate hospitalizations figure represents an increase of 10.7% from last year's edition, which counted 1955 inappropriate hospitalizations.

"The barometer data confirms what we have seen in practice and what social workers and internal medicine doctors have told us: this phenomenon is getting worse," APAH president Xavier Barreto told Público, describing the impact that inappropriate occupation of hospital beds has on management as "brutal". "When we discuss the situation of patients accumulating in emergency rooms, we're often talking about this type of cause, which hinders the flow of patients."

At national level, the barometer says, the lack of response from the National Network for Integrated Continued Care (RNCCI) was responsible for 44% of inappropriate admissions - as in the previous year - followed by the wait for a response in a residential facility for the elderly (ERPI), responsible for 30%.

It is, in fact, the lack of response in nursing homes that "represents the main reason for the number of days of inappropriate hospitalisations", reads the document, which points out that "the organisational causes of the integrated health system, in particular the delay in integration into mental health facilities for the chronically ill", under a 2015 circular, "also have a significant impact".

Xavier Barreto assumes that they are "concerned" about the implementation of the Recovery and Resilience Plan (PRR), because "there is no information on how the tenders are going" for new vacancies. "There was a specific line to increase the RNCCI's capacity by 50%. We're in the middle of 2024 and the PRR is to be implemented by the middle of 2026," recalls the official, who points to the creation of more places in the RNCCI and in nursing homes as the "most immediate solution" to help solve this problem of delayed discharges.

But the solutions don't end there. The barometer also suggests reducing red tape in administrative processes, more investment and support for informal carers and greater coordination between the health, social security and justice sectors (for example, a quicker response to the most closely monitored cases).

The number of inappropriate hospitalisation days is also high. The national average delay was 175 days per episode, which translates into a total of 378,068 days on 20 March. This is 13% more than in the 7th edition of the barometer.

According to the document, "in recent years there has been an increase in the percentage of inappropriate hospitalisation days in the internal medicine service". The barometer points out that 78% of these patients were admitted to medical wards and 76% were over 65.

In addition to the increased health risks of this phenomenon, there are high financial costs, which, according to the barometer, amounted to nearly 68.4 million euros on 20 March.

Extrapolating to one year - in other words, with no change in the situation - the costs could amount to 261 million euros. An estimate that represents an increase of 16% compared to the 7th edition, says the document.

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