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A Ttività S Anitaria E Scientific a 2020 ATTIVITÀ SANITARIA E SCIENTIFICA 2020 ATTIVITÀ SANITARIA E SCIENTIFICA 2020 INDICE PRESENTAZIONE 4 INTRODUZIONE 5 SPECIALE COVID-19 6 COVID-19. Risultati scientifici significativi nelle riviste a più elevato fattore di impatto 7 Prevenzione e controllo COVID-19 in Ospedale 10 1 ATTIVITÀ SANITARIA 18 Le attività assistenziali e gli indicatori di performance 19 Programma miglioramento continuo qualità dell’assistenza 40 2 ATTIVITÀ DEI DIPARTIMENTI 74 Dipartimento Anestesia, Rianimazione e Comparti Operatori 76 Dipartimento Chirurgie Specialistiche 78 Dipartimento Emergenza Accettazione e Pediatria Generale 83 Dipartimento Diagnostica per Immagini 87 INDICE Dipartimento Medicina Diagnostica e di Laboratorio 91 Dipartimento Cardiochirurgia, Cardiologia e Trapianto Cuore Polmone 95 Dipartimento Medico Chirurgico del Feto-Neonato-Lattante 99 Dipartimento Neuroriabilitazione Intensiva e Robotica 103 Dipartimento Neuroscienze 108 Dipartimento Terapia Cellulare, Terapie Geniche e Trapianto Emopoietico 113 Dipartimento Pediatrie Specialistiche e Trapianto Fegato Rene 117 Dipartimento Pediatrico Universitario Ospedaliero 120 3 ATTIVITÀ SCIENTIFICA 126 L'Attività scientifica e gli indicatori di performance 127 Produzione scientifica 128 Attività di ricerca 130 Finanziamenti per la ricerca 133 Collaborazioni scientifiche 136 Trasferimento Tecnologico 137 Biblioteca Medica 138 Formazione e Accreditamento ECM 140 4 RISULTATI SCIENTIFICI SIGNIFICATIVI NELLE RIVISTE A PIÙ ELEVATO FATTORE DI IMPATTO 142 5 DIREZIONE MEDICINA SPERIMENTALE E DI PRECISIONE 146 6 AREE DI RICERCA 150 Area di Ricerca Genetica e Malattie Rare 152 Area di Ricerca Malattie Multifattoriali e Malattie Complesse 157 Area di Ricerca Immunologia 163 Area di Ricerca Infettivologia e Sviluppo di Farmaci Pediatrici 168 Area di Ricerca Oncoematologia 173 Area di Ricerca Innovazioni Clinico Gestionali e Tecnologiche 177 7 PUBBLICAZIONI SCIENTIFICHE 182 PRESENTAZIONE Gestire un ospedale di alta complessità clinica, scientifica e amministrativa, come il Bambino Gesù, non è mai un compito facile, ma ci sono periodi più impegnativi di altri. Non c’è dubbio che il 2020, con l’emergenza Coronavirus, sia stato tra questi. L’Ospedale, come tutto il Paese, ha dovuto far fronte ad una situazione assolutamente inedita, con l’obiettivo di mettere in sicurezza pazienti, famiglie e personale, continuando ad assicurare la tempestività e la continuità delle cure ai nostri bambini e ragazzi. Sono particolarmente orgogliosa di quanto siamo riusciti a fare e intendo cogliere questa occasione per esprimere la mia profonda gratitudine a tutti i dipendenti e i collaboratori del Bambino Gesù: abbiamo sperimentato forse come non mai cosa significhi essere “servizio pubblico”, parte di un’unica grande comunità di cura. L’Ospedale ha saputo riorganizzarsi e reinventarsi, adeguando in fretta spazi e competenze per fronteggiare qualcosa di mai visto prima. Abbiamo lavorato a stretto contatto con le Istituzioni locali e nazionali, mettendo a disposizione la consulenza dei nostri specialisti negli organi di governo sanitario dell’emergenza, nei canali di informazione sanitaria per il grande pubblico, nei percorsi di accompagnamento per le famiglie e di formazione per i pediatri di libera scelta diffusi nel territorio. La crisi provocata dalla pandemia, con il lungo lockdown e i conseguenti impedimenti alla mobilità, ci hanno fatto sperimentare forme nuove di comunicazione sanitaria e distanza, favorendo di fatto il percorso di innovazione e digitalizzazione dell’Ospedale e la diffusione di esperienze di telemedicina. Il sito internet dell’Ospedale ha registrato quasi 10 milioni di contatti da tutta da Italia per 20 milioni di pagine visualizzate: un grande sforzo di informazione ed educazione sanitaria che ha contribuito a rassicurare le famiglie e a contrastare il fenomeno delle fake-news, ad esempio sul tema dei vaccini. Lo stesso impegno di formazione e comunicazione a distanza è stato profuso sul piano delle attività internazionali, con lo scopo di sopperire all’impossibilità di compiere missioni in presenza nei Paesi in cui normalmente operiamo. Il Bambino Gesù, per le famiglie e per i pazienti, non ha mai chiuso. E non ha mai smesso di fare ricerca e assistenza di alto livello, come dimostrano i numeri esposti in questo volume sui trapianti, sulle procedure interventistiche, sulle pubblicazioni scientifiche e i progetti di ricerca. Basti qui ricordare lo straordinario intervento chirurgico, in piena pandemia, che ha portato alla separazione delle due gemelline siamesi del Centrafrica unite per la testa (craniopago totale posteriore). Un’operazione che ha fatto il giro del mondo e che lo stesso Papa Francesco ha potuto apprezzare nelle parole di gratitudine della mamma delle bambine, nel giorno del loro Battesimo, eccezionalmente celebrato dal Santo Padre. Non smettiamo mai di migliorare e di dare il meglio di noi, di fronti alle difficoltà più grandi. Mariella Enoc Presidente Ospedale Pediatrico Bambino Gesù 4 ATTIVITÀ SANITARIA E SCIENTIFICA 2020 INTRODUZIONE Nel presentare lo scorso anno i risultati dell’attività assistenziale e scientifica dell’Ospedale Bambino Gesù avevamo definito il 2019 un “anno speciale”, per i risultati complessivamente raggiunti. Nell’introdurre la relazione sanitaria e scientifica del 2020 ci riappropriamo, ma questa volta con connotazioni in larga misura diverse, della definizione di “anno speciale”. Un anno che è stato drammaticamente segnato dalla pandemia, che ha condizionato la vita di tutti, richiedendo una riorganizzazione complessiva delle attività produttive, lavorative, assistenziali e della ricerca. Una calamità che purtroppo non si è ancora esaurita, nonostante le numerose risposte fornite dalla ricerca che ha messo in campo strumenti che ci autorizzano comunque a guardare al futuro con un cauto ottimismo. A questi sentimenti desideriamo associare una forte gratitudine nei confronti dei medici, degli infermieri, del personale delle professioni sanitarie, dei ricercatori, di tutto il personale dell’Ospedale, nonché della sua dirigenza, perché l’eccellenza dei risultati clinici e assistenziali raccontati in questo volume delineano uno straordinario impegno di sistema della comunità dell’OPBG nel conseguimento degli obiettivi della nostra missione. Nonostante le grandissime sfide presentate dalla pandemia, la preparazione all’emergenza e alle azioni di contrasto del rischio infettivo che sono state consolidate negli anni grazie al Programma di miglioramento continuo della qualità dell’assistenza, hanno consentito di garantire un’assistenza efficace e sicura sia ai neonati, bambini e ragazzi con infezione da SARS-CoV-2 che a tutti i pazienti con altre patologie. Con il riconoscimento dell’Ospedale come hub pediatrico regionale per il Covid-19, la risposta all’emergenza pandemica ha infatti comportato la sua riorganizzazione, con l’individuazione di aree Covid in cui sono stati accolti i pazienti in età pediatrica con infezione da SARS-CoV-2 e garantita la permanenza durante il ricovero dei genitori, fronteggiando situazioni in cui più componenti della famiglia avevano bisogno di cure ospedaliere. Allo stesso tempo, la riorganizzazione dell’Ospedale ha consentito l’accesso in sicurezza dei pazienti con altre patologie e la prosecuzione delle attività di alta complessità. Un dato esemplificativo è rappresentato dal numero di trapianti effettuati, che è continuato ad aumentare anche nel 2020 (+13,2% rispetto al 2019). Anche il peso medio dei ricoveri è aumentato (+6% rispetto al 2019), ad evidenza del fatto che l’Ospedale ha ridotto, come richiesto dall’evento pandemico, l’attività di bassa complessità riprogrammabile (riduzione del 6% delle prestazioni ambulatoriali, del 15% del numero di DH e del 21% dei casi di DS), ma continuato ad assicurare l’attività per l’alta complessità. L’attività di ricerca è stata gestita nel rispetto delle norme generali finalizzate alla prevenzione del contagio ed è stata condizionata dallo smart working, che ha significativamente ridotto i tempi di permanenza dei ricercatori nei laboratori. Nonostante questi limiti, i risultati sono stati fortemente positivi per tutti i più significativi parametri misurabili. In particolare, sono state prodotte 937 pubblicazioni, 86% delle quali eleggibili dal Ministero della Salute in base alla tipologia del riconoscimento istituzionale, per un valore complessivo di Impact Factor grezzo di 4.015 punti, corrispondente ad un incremento del 6,3% rispetto al 2019. Di particolare rilievo il numero complessivo dei progetti attivi, 719, prevalentemente nell’area clinica-traslazionale e nell’area biomedica, con oltre la metà degli studi, soprattutto di tipo interventistico, dedicati alle malattie e ai tumori rari. Tali attività sono state svolte in collaborazione con 2.282 Enti, 82% dei quali stranieri. I finanziamenti per la ricerca sono aumentati nell’ultimo anno del 15%, in particolare per il procacciamento attivo da parte dei ricercatori attraverso la partecipazione a bandi nazionali e internazionali. Il 2020 ha segnato anche la conclusione del settennato del Programma Quadro Horizon 2020 dell’Unione Europea, al quale l’OPBG ha partecipato con 28 progetti, classificandosi al quinto posto tra i partecipanti al settore “salute” e al secondo posto tra i 51 IRCCS. Da ultimo segnaliamo il deposito, nel 2020, di 5 nuove domande di brevetto, che hanno portato a 15 il portafoglio complessivo attuale delle famiglie brevettuali dell’OPBG. Rivolgiamo il nostro “grazie” a tutta la Comunità dell’Ospedale, la vera
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