Learnings from Italy. Value will be the common currency.

Prof. Dr. Fred van Eenennaam, VBHC Center Europe.

In recent days, it has become clear that cooperation in the fight against the corona outbreak is essential. In addition, a lot of money and resources are needed. Worldwide, there is a tremendous development in the healthcare field, in time of crisis, everything accelerates and all the impossible becomes possible. Collaborations arise between departments and healthcare institutions that go beyond the ideas of integrated practice unites and the treatment pathways for corona patients can be a good example for the organization of regular healthcare.

Having that said, due to the corona outbreak, almost half of the regular care is stopped. There is a reservoir of delayed outpatient checks and elective treatments that have to be made up, with all the consequential risks. There is of course no question, in times of crisis, that we also have to look ahead and learn from the recent developments. The developments in Italy, reported by Medscape, are used as perspective.

COVID-19: What Can the World Learn From Italy? - Medscape - Mar 13, 2020. Click here for full article What can we learn from Italy?

The first case of COVID-19 appeared in Italy on January 30th. A couple of Chinese tourists coming from Wuhan via Beijing were admitted to Spallanzani Hospital in Rome, highly specialised in infectious diseases. The same day, the Minister of Health Roberto Speranza announced an air traffic embargo for flights coming to Italy from any Chinese city, including the autonomous regions of Hong Kong and Macau, in an attempt to block the spread of the infection. In the days following the hospitalisation of the Chinese couple in Rome, a few new cases were detected in a group of Italians who were repatriated from the Wuhan region. Experts started to sigh in relief as all cases came from abroad and no local contagion seemed to show up.

The Alarm in the Middle of the Night

Then, quite abruptly, on February 20th at midnight, the Councillor for Welfare in Lombardy, Giulio Gallera, announced that Mattia, a 38-year-old Italian from the small city of Codogno, in Lombardy, was hospitalised for a severe case of atypical pneumonia and tested positive for coronavirus. He had not travelled to China nor had any contact with people coming from Asia. He was tested only because a young anaesthesiologist, faced with the worsening condition of the patient, broke protocol and asked for permission to test a patient with no apparent risk factors. Codogno was the focus of a local outbreak of the disease: new cases were identified in the following days and the whole area was put under strict quarantine for 2 weeks. But it was too late.

As of March 12th, Italy has 15,113 official cases, 1016 deaths and 1258 recovered patients. The whole country is on lockdown. Cities like Milan and Bergamo, in Lombardy, are facing an exponential growth of hospitalised people with COVID-19. Schools, universities, and most shops are closed (all except the ones selling basic goods like food, drugs, electronics, and warehouses) and the National Health System is trying to cope with the flood of patients needing ventilation support. Roberto Cosentini, head of the Emergency Department at Pope John XXIII Hospital in Bergamo, one of the most affected cities, has been living in the hospital for the last 3 weeks:

"It's like a wave," he says. "We have now around 60-80 new COVID-19 patients per day coming to the emergency. Most of them are in severe conditions and they arrive all together between 4 and 6 pm. We learnt that the respiratory distress worsens at the end of the afternoon and we now know that we will have to deal with most of the severe cases showing up one after another in a short time, every day." More inspirational stories or information packages? www.vbhc.nl/membership

COVID-19: What Can the World Learn From Italy? - Medscape - Mar 13, 2020.

The Impact on Oncology

When the lockdown was extended to the whole country, the association of medical oncologists (AIOM, Associazione Italiana di Oncologia Medica) published a statement inviting specialists to reschedule all 'non-urgent' activities, such as cancer screenings and follow-up visits for successfully- treated patients, and in some cases adjuvant therapy.

"The rationale is to make sure that the oncology wards, especially in general hospitals that are also treating COVID-19-positive patients, can respect all the safety procedures, including social distancing, for cancer patients who are being treated or may need to start a new treatment," explains vice- president of AIOM Saverio Cinieri, who is co-director of Milan's European Institute of Oncology (IEO). "This also reduces the social interactions of immunocompromised persons who are at higher risk both of infection and of developing more serious symptoms." AIOM recommended contacting patients via phone or e-mail, to verify which patients may need to be visited, and is developing an app for video consultations.

The critical situation in Italy, as described in the article of Medscape, shows some exceptional examples of high quality care. The Italian hospitals coordinate, collaborate and have optimal team dynamics showing that healthcare delivery is a real team sport. In addition, proof is given here that all patients benefit from protocols but no protocol fits any patient perfectly. What would have happened if the young anaesthesiologist, did not break the protocol? These are two of the four VBHC principles that need to be adhered to, to ensure high quality care. We have to find a way to learn from these event to make our healthcare system better and increase the value that is delivered.

As mentioned, almost half of the regular care has stopped. In Italy, non-urgent cancer screenings and follow-up visits are rescheduled and have to be made up later. Nobody disagrees on this, and everyone understands that there are more urgent things than this, but we still have to keep looking forward to ensure that this crisis is not going to spread to other medical conditions.

Integrated Practice Units

Patient flows An IPU is required to seamlessly align all the Digital care activities that a patient Maximum use of the requires on his cycle of capacity by mapping out In other words, VBHC 2.0. care... corona IPUs show the patient flows and Outome measures are used optimal collaboration optimal planning. more and more, and digital between departments. Why innovations are the answer don't we apply this to all to implement the next level care? of VBHC.

Healthcare will never be the same again as we grapple with these extraordinary situations. The focus and the perspective need to be changed and value will be the common currency across all stakeholders. The sustainable solution lies in the timely, preferably now, organization of the short and long-term organization of care, taking the learnings from this crisis with us.

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