Hospitals

The Hospital Network of the ASL of Frosinone is consistent with the Operational Plans 2013-2015 and is established in compliance with the indications set out in the Guidelines for the drafting of the Company Acts and the DCA no. U00412 of 26 November 2014 – DCA rectification no. U00368/2014 – Reorganization of the hospital network to safeguard the strategic objectives of returning from the health deficits of the Lazio Region (DCA no. U00247/2014), respecting in particular the following parameters:

• organisation according to the departmental model with adaptation of the Operating Units in relation to the standard parameters of the Lea Committee (1 Complex Operating Unit for every 17.5 public beds and Simple Operating Units equal to 1.31 of the complexes);
• counting in the Complex Operating Units of the OCUs without beds (Health Directorates, Pharmacy, Diagnostic Services);
• presence of 6 operating structures of which at least 4 are complex and 2 are simple departments per single Department;
• adoption of organizational measures to establish functional, intra- or interdepartmental areas to strengthen the integration between structures that share common objectives and welfare or management processes, without the conditions for the establishment of a Department and with the Manager in charge (without compensation of Department Director);
• organization by care areas for intensity of acute care (medical, surgical, maternal-infant) and creation of multi-specialty diurnal modules (medical and surgical);
• organisation of the UU.OO. of Surgery in modules operating 5 days a week to promote organisational appropriateness;
• organisation of multidisciplinary daytime areas with the aim of rationalising human resources;
• elimination of any duplication of care functions.

On the basis of these indications, 3 Hospital Centres are identified.

The three Hospitals are as follows:

• Frosinone-Alatri-Anagni Hospital, based in Frosinone, via Armando Fabi, tel. 0775 8821;
• Sora Hospital, based in Sora, Loc. San Marciano, 03039 Sora, tel. 0776 8291;
• Cassino Hospital, based in Cassino, via San Pasquale, 03043 Cassino, tel. 0776 39291.

As for the Presidium of Anagni, considered the O.D.G. voted by the municipalities of the north of the province (Acuto, Anagni, Filettino, Paliano, Piglio, Serrone, Sgurgola, Trevi in Lazio), a plan has been formulated for the reorganization of activities and an integration with the Hospital of Frosinone for the activities related to the 24-hour emergency coordinated by the Emergency Room of the P.O.F. Spaziani. All activities remain active and enhanced: specialist outpatient clinics, an oncological screening station, a dialysis centre, an emergency laboratory, radiology equipped with teleconsultation and remote diagnosis systems, the activation of the day service, day surgery and outpatient surgery, the activities of general medicine and services.

Discussions are underway with the Lazio Region and the Ministry of the Environment for the activation of prevention and treatment services for both people and the environment related to the pollution of the Sacco Valley. In this regard, always in agreement with the Region and the Ministry of the Environment, a Health and Epidemiological Surveillance Centre is planned to be located in Anagni. In the same Act proposal, in the Prevention Department, no. 2 Complex Operating Units related to the protection of food and livestock production.

With regard to the complementarity within the Frosinone-Alatri Unified O.P. and the synergies that will be achieved, it is expected, in compliance with the overall allocation of beds allocated, to maintain a General Medicine O.P.U. and a Rehabilitation O.P.U. at Alatri and the establishment of a homogeneous surgical functional area equipped with 10 ordinary O.P. and 10 short-cycle O.P. (week surgery) for surgical and orthopaedic diseases, further increased by 16 O.P. of multidisciplinary day surgery. 6 PP.LL. of sub-intensive therapy will be made available to support the surgical activity.

Nephrological activities and Dialysis will be maintained with 15 Seats and all support services for the assistance activity will be maintained. The Emergency Room will be equipped with 5 PP.LL. (2 of Obi and 3 of Temporary Observation), while at the same time a discharge room will be activated with the aim of reducing patient waiting times. The aforementioned structure involves the presence of 135 PP.LL in the Alatri structure. The reason for this reorganization lies in the possibility of differentiating the two structures, which have so far seen a duplication and overlap of their respective care activities, in a period dedicated to the management of more complex pathologies and in a supervision in which to deal with cases of medium-low complexity, applying those innovative care models that allow higher levels of appropriateness to be achieved. The geographical proximity of the two garrisons represents a further rationalization factor that, through the common management of personnel and technological resources, can allow significant economies of scale.

With regard to the Hospital of Sora, the Company accepts the suggestions received from the Municipal Administration because it goes in the direction of strengthening the oncological vocation of the Hospital of Sora, already planned by this Local Health Authority, both because it is consistent with regional indications. The improvement of the healthcare offer for cancer patients, however, requires a complex of coordinated and synergistic actions, aimed at expanding the range of services necessary for the creation of a network capable of guaranteeing the taking charge and integral management of the neoplastic pathology. It is therefore essential to implement all the actions to recruit the necessary professional figures and to strengthen the support services, including the finding of an expert surgeon in abdominal oncological surgery, the strengthening of digestive endoscopy, the activation of interventional radiology within the corresponding UOSD, the implementation of a “breast unit” that can make use of the contribution of a plastic surgeon, the creation of a pathological anatomy structure oriented to oncology, the provision of a psycho-oncology service, the strengthening of radiotherapy and the availability of nuclear medicine, pulmonology, endocrinology, cardio-oncology and preparation of anti-blastic drugs. Due to the particular orographic conformation of the territory that sees the crossing of two rivers (Liri and Fibreno), the confluence of three valleys (Roveto, Liri and Comino), and the high seismic risk, the health offer, in addition to the oncological address, must approach the standards of a 1st level GODDESS. Improvement and reinforcement actions have this horizon. This is why, compared to the past, a further UOC of Orthopaedics and SPDC is foreseen in the Business Deed.

As for the Cassino Hospital, it remains the indication of a first-rate GODDESS with all her own specialties. Compared to the previous Business Act, the separation of the UOCs in the medical field with a UOC of Medicine and a UOC of Pulmonology has been proposed again, with the further development of the recruitment of management and nursing staff, the planned activities can be further increased, as already done with the activation of an Emergency Medicine with 12 PP.LL. as an additional module of the Emergency Department.

The table below shows the current number of beds as recorded by NSIs as of 30 June 2014 and that provided for by the regional hospital network planning, to which must be added the beds, which do not meet the standards set by Law no. 135 of 7 August 2012, of the nursery and those of intensive short observation (IBO) that the Company intends to activate in all the Presidiums. It should also be pointed out that the availability of beds will be further increased by nursing and Hospice beds (15 PP.LL.) for the management of diseases currently improperly treated in acute care units.

The provincial offer of beds for acute patients is complemented by the equipment of the four accredited private Nursing Homes operating in the territory of the ASL (as reported in Article 4.1 of the Company Deed), redetermined by the DCA no. U00412/14.

With regard to post-acute beds (for which a standard of 0.2 per thousand in long-term care and 0.5 per thousand in rehabilitation is considered appropriate), the actual company offer is currently divided between public and private accredited as indicated in the table below.

Availability, according to DCA no. U00412/2014, of 979 public beds (of which 922 for acute and 57 for post-acute) and 391 accredited private beds (of which 99 for acute and 292 for post-acute) sets the total allocation of provincial beds at 1,370, equal to 2.75 beds x 1,000 inhabitants, as shown in the table below.

Attachment 3 of this Company Deed shows the beds for each Presidium. The provision of beds in the individual U.O.C., U.O.S.D. and U.O.S. will be assigned by separate provision of the Strategic Management on the basis of the available human resources and those recovered from the reorganization of hospitalisation activities.

The Hospital Health Director

The Hospital Health Director has governance and management responsibilities in relation to the provisions of current legislation and in particular:

• adopts the necessary standards for the best organization of technical health services;
• requires health or tax assessments relating to assigned personnel;
• establishes the criteria, in relation to the needs of the services, for the employment, destination, shifts and leaves of the health, technical, auxiliary and executive personnel in charge of the health services of the hospital facilities;
• verifies compliance with personnel management criteria;
• proposes temporary replacements of health personnel and health technicians to the Company;
• ensures and verifies the correct management of medical records in compliance with the regulations;
• manages the correct compliance with information flows, with respect to the timing and quality/completeness of the data;
• presents the annual report on the health progress of the Hospital;
• proposes the acquisition plan for sanitary equipment and furnishings;
• expresses an opinion, for health purposes, on building transformations;
• manages the supply necessary for the health operation of the Hospital for the maintenance of the patient;
• checks the regularity of health services and the application of the corresponding rates;
• takes care of dispatch procedures for the reimbursement of total or partial hospital expenses to foreign citizens not belonging to the European Union or to countries with which there are no bilateral agreements, to accident insurance institutions, to self-employed payers, etc. including accounting and payment;
• apply guidelines for the pricing of hospitalization and care services according to the criteria of the Regional Directives, outpatient services and the collection of citizens’ participation in spending as well as fees for professional services;
• takes care of the prompt transmission to the competent authorities of the complaints of contagious diseases found in the Hospital and of any other prescribed by the provisions of the Law;
• evaluates and authorises command requests for professional updating;
• manages and supervises the correct disposal of waste produced by the Hospital;
• provides for the implementation, by delegation of the General Manager, of the safety requirements for the work environments provided for by Legislative Decree no. 81/08 and subsequent amendments;
• defines the criteria for the management of waiting lists and verifies their implementation;
• verifies the appropriateness of hospitalisation times;
• manages the plan for the use of operating rooms, the methods of delivery of hospital health services, with particular reference to PACs, APAs, Day Surgery, Day Hospital;
• regulates and manages plans and guidelines for pre-hospitalisation, bed management and protected discharge.